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J Wound Care [journal]
- Commentary. [Comment, Journal Article]
- J Wound Care 2013 Feb; 22(2):83-4.
- Venous leg ulcer healing in primary care. [Letter]
- J Wound Care 2013 Feb; 22(2):98-9.
- Handling the sequelae of breast cancer treatment: use of NPWT to enhance patient independence. [Journal Article]
- J Wound Care 2013 Mar; 22(3):162, 164-6.
A cancer diagnosis can be an overwhelming experience and has devastating implications for an individual, their family and friends. Radical treatment, although often essential, can have its own health consequences. This case study describes the management of a 38-year-old woman with a portable, non-electrical negative pressure wound therapy device, suggesting benefits in terms of healing, patient independence and improved quality of life. The case study also highlights the importance of effective communication, patient involvement and empowerment in clinical decision-making, showing that an effective client-clinician relationship can help overcome the physical and emotional sequelae of this diagnosis.
- Use of 3D photography in complex-wound assessment. [Journal Article]
- J Wound Care 2013 Mar; 22(3):156, 158-60.
To review the evidence to support three-dimensional (3D) photographic imaging in wound care and undertake a feasibility evaluation of one device in the clinical environment.A literature review was undertaken of the role of stereophotogrammetry in wound care.Subsequently, a 3D imaging and data storage system was selected and evaluated in two representative case studies within the clinical environment of the Royal Centre for Defence Medicine.The review suggested that 3D imaging has the potential to provide more accurate data on which to base treatment decisions. In practice, the device was found to be relatively easy to operate and sufficiently robust to handle the demands of clinical practice. However, the high initial cost of the unit and the time taken to download images to the database meant that its benefits were limited to more complex wound types.Three-dimensional photography has the potential to play a role in management options;however, current technical issues limit its potential and the incorporation of a highly defined image (similar to that of a standard digital 2D photograph) within its 3D representation would make it more powerful.
- Wound 'dechronification' with negatively-charged polystyrene microspheres: a double-blind RCT. [Journal Article, Research Support, Non-U.S. Gov't]
- J Wound Care 2013 Mar; 22(3):144-6, 148, 150-2 passim.
To compare the efficacy and safety of negatively-charged polystyrene microspheres (NCM)with controls (saline soaks) in the treatment of hard-to-heal wounds of various aetiologies.Patients with one or more hard-to-heal wounds, defined as refractory to healing for at least 4 weeks, or those with exposed bone, tendon or ligament, were eligible for inclusion and were randomised to either NCM (PolyHeal; MediWound Ltd.) or controls, both applied twice daily for 4 weeks. Patients were monitored bi-weekly for an additional 8 weeks, while treated by standard wound care, at the investigators' discretion, and were re-evaluated 2 years after inclusion. The primary endpoint was defined as coverage of> 75% of the wound area by light-red granulation tissue after 4 weeks of treatment.Fifty-eight patients completed the study, 32 in the NCM group and 26 in the control group. The two most common wound types were those with primary etiologies of venous insufficiency and postoperative/post trauma. In the NCM group 47% of patients achieved > 75% light red granulation tissue after 4 weeks compared with 15% of patients in the control group (p=O.O I). The mean wound surface area in the NCM group was reduced by 39.0% after 4 weeks compared with 14.9% in the control group (p=0.02).The achievement of> 75% light red granulation tissue and reduction of mean wound surface area was also observed in the two main sub-groups (venous insufficiency and postoperative/post trauma), although it was not statistically significant, possibly due to the small sample size in each sub-group.This study demonstrates that compared to control treatment, NCM treatment of hard to-heal and chronic wounds improves formation of healthy granulation tissue and reduces wound size thus in fact 'kick-starting' the healing process and 'dechronifying' chronic wounds.
- Orthopaedic nurses' knowledge about pressure ulcers in Iran: a cross-sectional study. [Journal Article]
- J Wound Care 2013 Mar; 22(3):138-40, 142-3.
To assess nurses' knowledge about pressure ulcers in an Iranian orthopaedic ward.A cross-sectional, self-report questionnaire study using Pieper's Pressure Ulcer Knowledge Test (PUKT). Orthopaedic nurses' knowledge about pressure ulcers was examined in two teaching hospitals in Iran. The questionnaire consisted of 41 true or false assertions, categorised according to pressure ulcer classification and onset, wound characteristics and preventive measure.Of 68 nurses, 57 participated in this study (response rate of 84%); of the respondents, 68%(n=39) were women and 32% (n= 18) were men. Mean age of participants was 30.2 ± 5.1 years and mean years of experience was 6.9 ± 4.6 years. The overall rate of correct responses by nurses was 70.1%.Nurses had the highest level of knowledge in the pressure ulcer prevention category and the lowest in the pressure ulcer categorisation and onset section. No relationship was found between level of knowledge and nurses' years of experience.Pressure ulcer prevention is one of the most important roles of nurses in an orthopaedic setting. The results of this study suggest that orthopaedic nurses in Iran were not sufficiently knowledgeable about pressure ulcers. Therefore, there is a need to improve their knowledge with some targeted, educational programmes.
- Clinical outcomes of WF10 adjunct to standard treatment of diabetic foot ulcers. [Journal Article]
- J Wound Care 2013 Mar; 22(3):130-2, 134-6.
To study clinical outcomes and safety of WF I 0 as an adjunct to standard treatment for diabetic foot ulcers (DFU) and to determine the optimal number of WF I 0 cycles that should be administered.A prospective, open-label study of WF I 0 adjunct to standard treatment for severe DFU but salvageable foot was carried out between July 2009 and June 20 I 0. Patients were classified into three groups, according to common clinical presentations: neuropathic ulcer, ischaemic ulcer and severely infected ulcer. Ulcer assessments were monitored using the wound severity score (WSS; range 0-16).The clinical outcomes at 24 weeks were defined as 'good' (ulcer achieved endpoint [WSS=0-1 ]), 'fair'(improved from baseline [WSS=2-4]) and 'poor' (not improved or worsened [WSS > 4]).From a total of 129 patients, 21 ( 16%) presented with neuropathic ulcers, 49 (38%) with ischaemic ulcers and 59 (46%) with severely infected ulcers.AII neuropathic ulcers achieved either a good or fair outcome, with 81% achieving a good outcome, as did 49% and 81% of ischaemic and severely infected ulcers, respectively. Minor amputations were necessary for 14 patients (I I%), but no major amputation was required. Twenty seven patients (21 %) had transient reduction of haematocrit after WF I 0 therapy. One hundred and one patients (78 %) received only I cycle of WF I 0.WF I 0 as an adjunct to standard DFU treatment showed good clinical outcomes in the neuropathic ulcer group and the severely infected ulcer group. A side effect of WF I 0, transient reduction of haematocrit, was observed in 21% of patients. Most patients required only one cycle of WF I 0.
- SAP-containing dressings exhibit sustained antimicrobial effects over 7 days in vitro. [Journal Article, Research Support, Non-U.S. Gov't]
- J Wound Care 2013 Mar; 22(3):120, 122-4, 126-7.
To investigate the antimicrobial activity of SAP-containing wound dressings in vitro over a prolonged period of time (7 days) and to assess their ability to sustain the antimicrobial effect.SAP dressings were tested according to the JIS L 1902:2002 against the pathogens Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans.Additionally, effect on S. aureus and P. aeruginosa growth was investigated after a prolonged incubation period of 7 days. Furthermore, both SAP dressings were repeatedly inoculated with P. aeruginosa suspension and, after 7 days, microbial growth under the dressings was evaluated.Both SAP-containing wound dressings tested exhibited a significant to strong antimicrobial activity against Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Candida albicans in vitro. Moreover, it could be shown that they were able to sustain antibacterial efficacy over a prolonged period of time. Using a direct incubation method with repeated re-inoculation of the dressing samples, it could be shown that growth of P. aeruginosa was reduced after 4 days of treatment and completely inhibited after 7 days. No significant differences were observed between the two SAP-dressings tested.These in vitro experiments impressively demonstrated the antimicrobial mechanism of SAP-containing wound dressings: rapid up-take of fluid, binding of microorganisms to the SAP-core, and retention of the bacteria inside the dressing. Moreover, it could be shown that they are able to exhibit their antimicrobial activity over a prolonged period of time unless the amount of fluid present exceeds their fluid-handling capacity.
- Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs. [Journal Article, Research Support, Non-U.S. Gov't]
- J Wound Care 2013 Mar; 22(3):109-10, 112-8.
To estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose dressing (CMC [Aquacel]) and four super absorbent dressings (DryMax Extra[DM], Flivasorb [F], Kerramax [K] and sachet S [S]) in the treatment of highly exuding chronic venous leg ulcers (VLUs) in the UK, from the perspective of the National Health Service (NHS).A decision model was constructed depicting the patient pathways and associated management of a cohort of 439 patients with highly exuding chronic VLUs of;;: 3 months of age. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN)database (a nationally representative database of patients registered with general practitioners (GPs) in the UK) who were treated with one of the five dressings. The model estimated the costs and outcomes of patient management over 6 months and the relative cost-effectiveness of using each dressing.Patients' mean age was 73.1 years, and 46% were female. Between 39% and 56% ofVLUs healed by 6 months. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis. The 6-monthly NHS cost of managing a VLU with S was £3700 per patient, which was 15-28% lower than the cost of managing patients with the other three super absorbents. Additionally, use of S improved patients' health status to a greater extent than the other three super absorbents, since S-treated patients accrued 0.3-3% more QALYs. Starting treatment with S was the preferred strategy followed by DM, K and Fin that order.Within the limitations of the data set,S affords the NHS a cost-effective treatment for managing highly exuding chronic VLUs of ≥3 months of age, compared with DM, F, K and CMC.
- The challenge of integrity. [Editorial]
- J Wound Care 2013 Mar; 22(3):107.