bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of having a child with complex and continuing health needs on employment
Authors: Hewitt-Taylor Jaquelina 
Published: May 2014

This paper discusses the experiences of parents whose children have complex and continuing health needs in relation to their ability to engage in paid employment. The findings are taken from a qualitative study of parents’ experiences of having a child who has complex and continuing health needs. The principal findings of the study are that having such a child often alters their parents’ ability to engage in paid employment and the type of employment they can consider. The nature of their children’s needs means that they usually need more opportunities for flexible and part-time working than other parents. In addition, the availability of suitable out-of-school childcare for children with complex needs means that parents are often very limited in the hours they can work. Changes in their employment status can mean a significant reduction in the family’s income, and changes in the ways in which parents perceive themselves and in how others perceive them. Service providers should consider the effect that the support offered may have on parents’ ability to return to work and, where parents cannot return to work, the loss of earnings that this occasions means families may need support to enable them to appropriately access the benefits to which they are entitled. In addition, where parents’ roles are significantly changed by being their child’s carer, nursing staff should be aware of the effect of society devaluing such roles on parents’ sense of self. While this is a small study, it contributes to an increasing body of evidence that should inform the delivery of support for children and their families.
Microbial involvement in chronic wound malodour
Authors: Bowler P.G. , Davies B.J. , Jones S.A. 
Published: May 2014

The role of specific micro-organisms in producing chronic wound malodour was investigated by directly comparing odour severity and microbiology in infected and non-infected leg ulcers. Malodour was most frequently associated with infected wounds involving mixed aerobic and anaerobic, Gram-positive and Gram-negative microbial populations. Infected ulcers that were not characterised by an offensive odour were rarely colonised with anaerobic bacteria. A reduced incidence of pigmented and non-pigmented Gram-negative anaerobes (Bacteroides spp, Prevotella spp, Porphyromonas spp) was evident in non-infected, non-malodorous leg ulcers. These observations emphasise the significance of specific anaerobic bacteria in the generation of wound malodour, and it is probable that their effect is potentiated by coexistence with mixed facultative micro-organisms.
The palliative management of fungating malignant wounds
Authors: Grocott P. 
Published: May 2014

A study focusing on patients' experiences of exuding wounds and investigating novel dressing systems designed to meet individual needs This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs. A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease. A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection. The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalise beyond the individual cases. Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and,
Comparison of the healing rates and complications of three four-layer bandage regimens
Authors: Vowden K.R. , Mason A. , Wilkinson D. , Vowden P. 
Published: May 2014

This randomised controlled study compares the healing rates, complication and patient and staff acceptability of three four-layer bandage regimens for leg ulcers. A total of 149 patients were recruited into the study, of whom 50 received the original Charing Cross system (Parema) and 49 a commerically available kit, Robinson Ultra Four (Robinson). No significant difference was found in the healing rates of the three systems. Overall 12 weeks' healing was 65%, while the 20-week healing rates for the individual systems were 87% (CX4L), 84%(Parema) and 83% (Robinson). Analysis of known risk factors for delayed healing showed that no bandaging systems had an advantage over the others. Staff familiarity resulted in an initial preference for teh CX4L but there was no bandage preference by the end of the study. The data suggest that none of the systems has an advantage over the others and that cost savings can be made by pursuing a competitive pricing policy.
Living with a chronic leg ulcer: an insight into patients' experiences and feelings
Authors: Douglas V. 
Published: May 2014

Objectives: This study sought to ascertain patient need and help health-care professionals to understand the effects of chronic leg ulceration from a patient's perspective. Method: A qualitative grounded theory approach was used. A purposeful sample of eight participants (six females and two males) was selected. All were under the care of a district nurse and had over a year's history of venous leg ulceration. Data were collected by interview. Results: Five major categories developed, relating to the ‘physical experience’, ‘loss of control’, ‘vision of the future’, ‘carer's perspective’ and ‘health-care professional and patient relationship’. Conclusion: Although the physical and psychological effects of leg ulceration featured prominently in this study, these were heavily influenced by the relationship between the participant and the health-care professional. Declaration of interest: None.
Using an artificial neural network to predict healing times and risk factors for venous leg ulcers
Authors: Taylor R.J. , Taylor A.D. , Smyth J.V. 
Published: May 2014

Objectives: This study aimed to identify the risk factors that influence the healing process of venous leg ulcers treated with compression bandaging, with a view to predicting healing time. Method: A retrospective cohort study was performed on data collected prospectively on 325 consecutive patients presenting with 345 venous ulcers at the Salford Primary Care Trust leg ulcer clinic between January 1997 and December 1999. Use of an artificial neural network (ANN) technique accurately predicted the healing times for 68% of the patients. Results: The ANN demonstrated that healing was significantly related to a history of previous leg ulceration, ‘quite wet’ ulcer exudate, high body mass index, large initial total ulcer area, increasing age and male gender. Conclusion: The ability to identify at presentation ulcers that might be resistant to standard therapy would allow early consideration of more radical treatments such as hospitalisation, wound debridement or venous surgery. Declaration of interest: None.
Measuring the size of ulcers by planimetry: a useful method in the clinical setting
Authors: Öien R.F. , Håkansson A. , Hansen B.U. , Bjellerup M. 
Published: May 2014

Objective: The aim of this study was to compare four measurement methods. Digital planimetry was compared with mechanical planimetry, placing the film over graph paper and counting the squares (grid tracing), and multiplying the two maximal perpendicular diameters of the ulcer (diameter product). Method: Twenty patients with 50 chronic leg ulcers of various aetiology and sizes (20 ulcers were ≤3cm2, 15 ulcers were >3cm2 and ≤10 cm2, and 15 ulcers were >10cm2) were enrolled consecutively into this study. Ulcer area was calculated from film transparency tracings using a digital planimeter, a mechanical planimeter, grid tracing and diameter product. Results: The mean difference of digital planimetry versus mechanical planimetry, grid tracing and diameter product was 0.51cm2, 0.72cm2 and −5.38cm2, respectively. For all methods difference tended to increase with ulcer size. Conclusion: Digital and mechanical planimetry, together with grid tracing, appear to be appropriate means of obtaining accurate surface area measurements. Digital planimetry is a quick and practical method and could therefore be recommended in the clinical setting. Declaration of interest: The digital planimeter was loaned by Mölnlycke Health Care
A trial to assess the efficacy and tolerability of Hyalofill-F in non-healing venous leg ulcers
Authors: Colletta V. , Dioguardi D. , Di Lonardo A. , Maggio G. , Torasso F. 
Published: May 2014

Objective: This single-centre, open, uncontrolled pilot clinical trial set out to assess the efficacy and tolerability of Hyalofill-F (a partial benzyl ester derivative of hyaluronan), used in combination with compression bandaging, in the treatment of venous leg ulcers. Method: The 20 patients enrolled into the study had venous insufficiency and a leg ulcer that had been refractory to treatment for one month. Treatment was continued for eight weeks, with weekly assessments. Results: During the study period four of the patients' ulcers healed completely. An average wound area reduction of 53.5% was seen in the ulcers that did not heal. Differences in ulcer area and ulcer depth between the initial and final visit were significant (p<0.01, p=0.03). The average healing rate (cm2/week reduction) was 1.26 ±1.7 (standard deviation). A calculated prognostic index was used to identify patients at high risk of a poor response to compression therapy (10% probability of wound closure at 120 weeks). These patients demonstrated a mean 63% decrease in wound area after eight weeks of treatment with Hyalofill-F plus compression bandaging. All wounds showed a positive response in terms of granulation-tissue formation. The comfort of the dressing was described as excellent. Conclusion: The hyaluronan derivative showed promising results in initiating the healing process in chronic venous ulcers. It was found to be well tolerated and safe to use. However, further clinical trials should be performed involving a control group to verify these data. Declaration of interest: This study was sponsored by Fidia Advanced Biopolymers, Italy.
Open surgical wounds: how does Aquacel compare with wet-to-dry gauze?
Authors: Cohn S.M. , Lopez P.P. , Brown M. , Namlas N. , Jackowski J. , Li P. , Mishkin D. , Lopez J.M. 
Published: May 2014

Objective:To compare the healing rates of a hydrofibre dressing (Aquacel) and normal wet-to-dry gauze in the treatment of open surgical wounds.Method:Fifty patients with open surgical wounds were randomised to receive either saline-moistened gauze or Aquacel. The rate of wound healing was measured as ml/day (deep wounds) or cm2/day (superficial wounds) at each dressing change until an investigator blinded to the patient group diagnosed the wounds as having healed or the patient was withdrawn from the study.Results:Of the 50 patients, seven were withdrawn from the study after the first evaluation. Of the remaining 43 patients, 21 had been randomly allocated to the gauze group and 22 to the Aquacel group. For deep wounds, a mean change in the wound healing rate of 1.9 ±1.3cm3/day was reported for the gauze group and 2.9 ±2.3cm3/day for the Aquacel group. These results approach statistical significance (p=0.082). For superficial wounds, the mean change in the healing rate was 1.6 ±1.5cm2/day for the gauze group and 1.9 ±2.2cm2/day for the Aquacel group, but this was not statistically significant.Conclusion:Aquacel appears to be at least as effective as wet-to-dry gauze in the healing of open surgical wounds.Declaration Of Interest:This study was funded by ConvaTec and the University of Miami School of Medicine, US.
How patients with diabetes who have foot and leg ulcers perceive the nursing care they receive
Authors: Ribu L. , Wahl A. 
Published: May 2014

Objective: This Norwegian study set out to explore the nursing care experienced by patients with diabetes who have a foot and/or leg ulcer. Method: A qualitative method was used, with in-depth recorded interviews of patients living at home and receiving district nursing care. Seven patients were interviewed at home for 45 minutes to two hours. Interviews were transcribed and analysed using Kvale’s thematic and meaning analysis. Results: Several themes emerged, even though sample was not a homogeneous group: the expert patient (where patients acquired knowledge about their treatment and then passed this on to new and inexperienced nurses); fragmented nursing care (caused by lack of continuity in care); impersonal nursing care (where nurses did not view the patient as an individual, but focused solely on their wound); the ideal nurse (nursing attributes the patients valued most highly, such as engaging with them and attempting to understand their situation). Conclusion: Crucial to the successful treatment of patients with diabetes who have foot and/or leg ulcers is an understanding of their feelings about their ulcer and its impact on their quality of life. Further research in this area is recommended. Declaration of interest: None.
Pressure ulcer prevention: evaluation of an education programme for Swedish nurses
Authors: Gunningberg L. 
Published: May 2014

Objective: To investigate the effect of an education programme for 20 registered nurses on the following three areas: nurses’ knowledge of pressure ulcer risk and prevention; nursing documentation of ulcer prevention; routine use of prevention strategies. Method: The study had a quasi-experimental design. Data were collected immediately before and after the education programme and at eight-month follow-up. To measure knowledge of pressure ulcer management, a questionnaire was distributed to course participants (n=19) pre- and post-education. Nursing documentation (n=138) was audited pre- and post-education. To gain information on the routine use of prevention strategies, head nurses (n=20) were interviewed and the patients’ care environment (n=21) was observed pre-education, while a nurse questionnaire was completed (n=15) at the eight-month follow-up. Results: In relation to pressure ulcer prevention, nurses’ knowledge, documentation and ward routines were unsatisfactory before the education programme. However, the eight-month follow-up showed that 11 nurses (55%) had implemented new ward routines. Documentation was still lacking after the programme, although it was more detailed. Conclusion: The education programme succeeded in encouraging and empowering the nurses to change clinical practice. Declaration of interest: None.
Factors influencing concordance with compression stockings after venous leg ulcer healing
Authors: Jull A.B. , Mitchell N. , Aroll J. , Jones M. , Waters J. , Latta A. , Walker N. , Aroll B. 
Published: May 2014

Objective: To investigate the factors influencing patient concordance with compression stockings after venous leg ulcer healing. Method: In 2001 patients discharged from a specialist leg ulcer service in New Zealand were approached to participate in a structured interview about their use of compression stockings in the first six months following venous leg ulcer healing. Univariate analyses were performed to identify significant associations between factors and stocking use. Multiple logistic regression was employed to model the factors associated with frequency of stocking use. Results: A total of 163 patients were identified, of whom 129 (79%) agreed to participate. Sixty-seven (52%) reported wearing stockings every day for the first six months after their ulcers had healed, 21 (16%) stated that they had worn them most days, seven (5%) had worn them occasionally and 29 (22%) had not worn them at all after their ulcer had healed. Five (4%) did not provide data. Two factors distinguished those who wore stockings from those who did not 75% of the time: the belief that wearing stockings was worthwhile and the belief that stockings were uncomfortable to wear. Commonly cited factors, such as age, sex, difficulty in applying stockings and cosmetic appearance were not significantly related to stocking use. Cost did not seem to influence the decision to purchase compression stockings. Conclusion: Many factors previously thought to influence concordance appear to have little impact on compression-stocking use in people whose venous leg ulcers had healed. Declaration of interest: None.
An evaluation of Hyalofill-F plus compression bandaging in the treatment of chronic venous ulcers
Authors: Taddeucci P. , Pianigiani E. , Colletta V. , Torasso F. , Andreassi L. , Andreass A. 
Published: May 2014

Objective: Hyaluronan, a component of the extracellular matrix, plays a significant role in several aspects of tissue repair and the wound healing process. Method: In this Italian study Hyalofill-F, a partial benzyl ester derivative of hyaluronan, used in combination with compression bandaging, was compared with the well-established therapy in Italy of non-adherent gauze plus compression therapy in the treatment of chronic venous leg ulcers. Results: Hyalofill-F plus compression bandaging performed significantly better than non-adherent gauze plus compression bandage in all of the clinically relevant efficacy parameters. Mean reduction in ulcer area in the hyaluronan-derivative group was 8.1cm2 after eight weeks of treatment, compared with 0.4cm2 in the comparator group. The resulting difference of 7.7cm2 between the two groups was statistically significant (p=0.0019). Furthermore, statistically significant results in favour of the hyaluronan-derivative group were obtained in the following: speed of epithelialisation; levelling of the margins; degree of maceration; pain intensity and frequency. Conclusion: Hyalofill-F plus compression bandaging resulted in an earlier and greater decrease in ulcer area compared with non-adherent gauze plus compression bandaging, thereby supporting its use in the treatment of chronic venous ulcers. Declaration of interest: None.
An Indian community-based epidemiological study of wounds
Authors: Gupta N. , Gupta S.K. , Shukla V.K. , Singh S.P. 
Published: May 2014

Objective: To establish the prevalence of wounds in a community, with an emphasis on chronic lower extremity wounds, and to identify the various aetiological factors involved. Method: A cross-sectional study was conducted to screen the population of two nearby communities (one urban and one rural) in India for wounds. This involved conducting a door-to-door survey between July 2001 and February 2003. Results: The prevalence of wounds in the population studied (n=6917) was 15.03 per 1000. The prevalences of acute and chronic wounds were 10.55 and 4.48 per 1000 of the population respectively. Conclusion: The most common site for both acute and chronic wounds was the lower extremity. In contrast to Western studies, the most common aetiology for a chronic lower extremity wound was an untreated acute traumatic wound. This in turn highlights the need to establish community-based wound-care teams in India. Declaration of interest: None.
The prevention of heel pressure ulcers using a hydropolymer dressing in surgical patients
Authors: Bots Th.C.M. , Apotheker B.F.G. 
Published: May 2014

Objective: A trial of a self-adhesive hydropolymer foam dressing (Tielle, Johnson & Johnson) demonstrated that it prevented the development of friction-generated pressure ulcers on the heels of ICU patients. Following the trial, use of the foam dressing became a standard preventive measure in the ICU and the prevalence of heel ulcers decreased by 72% in two years. This follow-up study evaluated the foam’s effectiveness in preventing heel pressure ulcers in surgical patients. Method: A total of 140 surgical patients were screened over a four-month period. They were assigned to one of two groups, depending on their pressure ulcer risk score and the anticipated length of the surgical procedure. The foam dressing was used as a barrier on the heels, depending on the patient’s risk status, which was assessed using a modified Norton scale, and the duration of their surgery. Heels were inspected on a daily basis for up to 10 days. All 23 patients in the group whose surgery lasted less than 90 minutes dropped out of the study as they were discharged with insufficient data. Results: A 76.7% reduction in heel pressure ulcers was achieved with this preventive measure. Conclusion: Use of an adhesive foam dressing on surgical patients can prevent heel ulcers. Research is needed on the effects of friction on the heel during the transfer and movement of surgical patients. Declaration of interest: This study was sponsored by Johnson & Johnson Medical.
Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients
Authors: Baatenburg de Jong H. , Admiraal H. 
Published: May 2014

Objective: This study compares the total cost of treatment, skin-condition management and prevention of skin breakdown of perianal/buttock skin in incontinent patients receiving 3M Cavilon No Sting Barrier Film (Cavilon NSBF) and zinc oxide oil. Method: This single-centre open-label prospective randomised study involved 40 patients with at least moderate skin damage resulting from incontinence. Patients were randomised to receive either zinc oxide oil or Cavilon NSBF and were treated for 14 days. The study products and other treatment-related products used were recorded, as was the time needed to cleanse the application site and apply the product. Results: Use of both products resulted in an improvement in skin condition after 14 days, but this was significantly better with Cavilon NSBF than zinc oxide oil. Cavilon NSBF was more cost-effective as fewer applications were required, less time was spent applying the skin barrier product and faster healing rates were achieved. The cost-effectiveness ratio per treatment group showed an improvement of one point in the total score of the skin-assessment scale costs: ₠28.36 for Cavilon NSBF versus ₠98.06 for zinc oxide oil. Conclusion: Both products resulted in an improvement in skin condition after 14 days, but Cavilon NSBF was found to be more cost-effective. Declaration of interest: This study was supported by an educational grant from 3M.