Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Chronic wounds are a major healthcare problem costing the United States billions of dollars a year. The American Academy of Dermatology has underscored the significance of wound care in dermatological practice. It is critical for all dermatologists to understand the elements of diagnosis and therapy. We emphasize major aspects of diagnosis and present a simple classification of wound dressings with guidelines for usage and relative cost data. Learning objective After completing this learning activity, participants should be able to diagnose common types of chronic wounds, formulate a therapeutic plan, and describe the major classes of topical therapies and dressings for the chronic wound.

http://www.manukahonning.no/uploads/3/9/6/3/39639435/2008_treating_the_chronic_wound_a_practical_approach_to_the_care_of_nonhealing_wounds_and_wound_care_dressings.pdf

Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings

The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1742-481X.2012.01097.x

Extending the TIME concept: what have we learned in the past 10 years?(*).

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

/pdf/consensus-on-wound-antisepsis-update-2018-56xy5tzcqf.pdf

Consensus on Wound Antisepsis: Update 2018

Criteria used to identify infection may often be restricted to the presence of pus, or pus with inflammation1. Traditional criteria have been used in many surveys and their advantage is that they are simple, reproducible and easily recognised by different observers. However, identification of infection may be difficult in some circumstances, and identifying patients who are likely to develop infection is rare.

Criteria for identifying wound infection

All authors were members of the consensus meeting panel; * Chair of the panel. Full author details in Box 1 In spring 2010, a multidisciplinary group of clinicians met in London to discuss the issue of bacterial management in wound healing. The clinical world is currently facing a range of new challenges and health care is becoming increasingly intensive with ever-higher expectations of positive outcomes from both the healthcare industry and those it serves. As our understanding of the intricate balance between wound healing and the bio-community of organisms living within the wound expands, clinicians face new challenges in providing effective strategies to manage wound bioburden without inducing pathogen resistance and negatively influencing the healing process.

PHMB and its potential contribution to wound management

Objective: To provide ‘in use’ clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive ...

Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study.

Objective: This open, non-comparative, multi-centre investigation examines the use of a new superabsorbent polymer (SAP) wound dressing used for exudate management (in medium-to-high exuding wounds) in a patient population with a variety of wound types The primary objective of this study was to evaluate the fluid management capabilities of the dressing Method: Both acute and chronic wounds with moderate-to-high exudate production levels were assessed (over a period of two weeks) as requiring exudate management, with a SAP dressing, Zetuvit Plus (designated RespoSorb Super in other countries), as part of their normal treatment regimen Clinicians recorded a subjective assessment of exudate management and its impact on periwound skin conditions In addition, wound bed preparation, healing trajectory and pain level reduction were monitored to give an insight into the clinical implications of using this dressing Data was also collected from clinicians and patients on clinical performance of the dressing R

An observational study of a superabsorbent polymer dressing evaluated by clinicians and patients.

Based on the outcome of a series of symposia, this series aims to answer the question, 'what is compromised wound healing and how do we increase our understanding of chronic wounds?' Ultimately, we hope to explore the feasibility of developing a chronicity predictor. Many venous leg ulcers fail to heal when treated with compression and dressings that simply create a moist wound environment. Promogran is designed not only to produce a moist wound environment but also to inhibit protease activity, counteract a pro-oxidant environment, protect growth factors and modulate fibroblast activity. In two case reports concerning hard-to-heal venous leg ulcers, use of Promogran resulted in reduced exudation and stimulation of healing. Clinical observations found with these ulcers were consistent with Promogran's proposed mode of action.

Use of Promogran to treat venous leg ulcers.

Patient involvement in their own treatment can enable those with wounds in the community to play an active role in the management of their condition by, for example, completing dressing changes between health professional visits. The original primary study was undertaken to assess the clinical effectiveness of Zetuvit Plus Silicone Border (ZPSB) on exudate management. This retrospective sub-group analysis is aimed to demonstrate the effectiveness of a superabsorbent polymer (SAP) dressing (ZPSB) in enabling patients or their carers to undertake unsupervised dressing changes on their own. ZPSB was found to be clinically effective in this subgroup of patients, while also having additional features that enabled the patient to self-care. Overall, ZPSB enabled the patient to be part of their treatment plan and play an active role in the care of their wounds, thereby promoting self-care. This had a positive effect on nursing time saving and patient satisfaction.

Clinical evaluation of a superabsorbent polymer dressing in enabling self-care of wounds.

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