Abstract: Eventually, you will completely discover a additional experience and ability by spending more cash. yet when? get you agree to that you require to acquire those every needs later than having significantly cash? Why don't you try to get something basic in the beginning? That's something that will guide you to comprehend even more vis--vis the globe, experience, some places, gone history, amusement, and a lot more?

Abstract: • 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 (χ2[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. Se...

Abstract: Objective: To investigate the evidence exploring the experiences of patients with fungating wounds and associated quality of life, and to subsequently provide recommendations to how these implications may be addressed in practice. Method: Using a systematic approach, a comprehensive literature search was conducted to investigate the most appropriate and relevant evidence regarding the experiences of patients with fungating wounds. Results: Studies unveiled the enormity of the unrelenting, unique and devastating consequences that these wounds have on an individual's life and that every domain of their life is negatively affected. Conclusion: These findings must galvanise nurses to become aware of the extent of the devastation experienced and aspects of life affected by these wounds. The issues raised have multifaceted and challenging implications for practice; however, all aspects need to be addressed and satisfied in an attempt to improve the quality of life of individuals with fungating wounds. Declarati...

Abstract: 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. Surgi...

Abstract: Objective: To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs). Method: A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane library, EMbase, EBSCohost, Springer link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. the literature was screened, the data were extracted and the methodological quality of the included studies was assessed. meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage. Results: Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. the results of meta-analyses sugges...

Abstract: Objective: To evaluate healing of chronic diabetic foot ulcers (DFUs) with use of dehydrated human amniotic membrane (dHAM) in patients failing under standard of care treatment. Method: The study population was identified from patients with chronic DFUs enrolled in a randomised trial comparing standard care with standard care with the addition of dHAM. The present study included patients that failed to heal (defined as <50% decrease in wound size after 6 weeks, or not completely healed by 12 weeks of treatment) with standard care. One week after withdrawal from the randomised trial, these patients were offered treatment with standard care and bi-weekly application of dHAM. Subsequent evaluation of clinical records was made with IRB approval and patient consent. Each patient was used as their own control to compare wound size reduction between treatment periods, and healing rates within the 12-week dHAM treatment period. Results: Eleven patients were included in the study. Mean wound chronicity was 21.1 ± ...

Abstract: • Objective: to evaluate the effectiveness of a Telehealth system, using digital pen-and-paper technology and a modifed smartphone, to remotely monitor and support the effectiveness of wound management in nursing home residents. • Method: A randomised controlled pilot study was conducted in selected nursing homes in bradford, which were randomised to either the control or evaluation group. All patients with a wound of any aetiology or severity, resident in the selected nursing homes were considered eligible to participate in the study. residents in the control homes who had, or developed, a wound during the study period, continued to receive unsupported care directed by the nursing home staff (defined as ‘standard care’), while those in the evaluation homes received standard care supported by input from the remote experts. • Results: thirty-nine patients with a wound were identified in the 16 participating bradford nursing homes. Analysis of individual patient management pathways suggested that the system...

Abstract: Objective: To determine the net cost of hospital-acquired and pre-admission pressure ulcers (PUs) in an acute-care setting in Ontario, Canada. Method: Cases of PUs were identified among hospitalised patients using Ontario Case Costing Initiative (OCCI) data from 2002–2006. Inpatient costs included direct and overhead costs. To determine the net cost of PUs, cases were matched controlling for age, gender, most responsible diagnosis and comorbidity. Mean net costs were estimated using Bayesian linear mixed models methods. Results were also reported by PU severity. Results: In our study, there were 1351 cases of hospital-acquired PUs and 2523 cases of pre-admission PUs over 5 years. Net cost of hospital-acquired PU ranged between CA$44 000 for a category II PU to CA$90 000 for a category IV PU. For pre-admission PU net cost was between CA$11 000 to CA$18 500 for category II and category IV PU, respectively. The net cost of treating hospital-acquired PU is higher than pre-admission PU. Costs increase with inc...

Abstract: 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 comp...

Abstract: Objective: To explore how women living at home with a malignant fungating wound (MFW) cope with such wounds. Method: To explore coping through the lived experiences of patients a methodological framework, using Heideggerian hermeneutic phenomenology and semi-structured interviews. Nine patients were interviewed from January until November 2009. Results: The results are divided into two categories: ‘living with a MFW’ and ‘feeling different’. These categories demonstrate how it is to live with the unpredictability, and uncontrollability of a MFW due to symptoms such as malodour, bleeding, exudate, pain and itching. The loss of control of the body boundary due to uncontrollable symptoms led to significant levels of distress and suffering for the patients. Different coping strategies were used to live with this wound. Conclusion: This study demonstrates how difficult it is to live and cope with a malignant fungating wound. Coping strategies, including going into isolation, or denying any issues, were used. W...

Abstract: 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 Categ...

Abstract: • Objective: To estimate the wound-care related costs in two hospitals in Denmark. • Method: A point-prevalence survey with a focus on resource consumption was carried out during a representative 1-week period in March 2010, in two hospitals in Denmark: Regional Hospital viborg, in the Viborg Municipality and Hillerod Hospital, in the Horsholm Municipality. Data were collected during a 2-day period for inpatients and outpatients in the hospitals and over a full week in the municipalities. The survey included information on the numbers, types and locations of the wounds, as well as resource consumption related to dressing changes. The estimation of costs was based on representative cost levels, including the salaries of health professionals or nurses and the cost of dressings and hospitalisation provided. • Results: In total, 33% (n=830) of inpatients had a wound. The majority of these were surgical/trauma wounds (25%), while pressure ulcers, leg ulcers and diabetic foot ulcers accounted for 3.3%, 1.7% and...

Abstract: Laboratory-based clinical investigations have shown that maggots and their secretions promote, among other activities, fibroblast motogenesis and angiogenesis. These events would contribute to re-granulation if translated to the wound environment. Maggot secretions also have ascribed antibacterial actions and may exhibit anti-inflammatory effects. Many of these biological events would be lost in the presence of necrotic tissue, making debridement a prerequisite for the release of larval-secreted secondary beneficial effects on the wound. We argue that Larval Debridement Therapy (LDT) should be considered as a primary and secondary treatment in wound management, with the primary application designed to debride the wound, and with subsequent applications to the debrided wound targeted to cellular events that promote healing. This review lends support to a re-evaluation of larval application protocols, in order to optimally harness the potential secondary beneficial clinical effects of larval therapy.

Abstract: Objective: To determine undergraduate nurses' knowledge of and attitudes towards pressure ulcer prevention Method: A quantitative, cross-sectional survey design was used for this study Ethical approval was received A convenience sample of fourth-year undergraduate nurses was selected to participate (n=60) Data were collected using a pre-designed questionnaire Results: Overall, the participants showed a positive attitude towards pressure ulcer prevention but displayed poor knowledge of pressure ulcer prevention Interestingly, having a high level of competency corresponded with having a positive attitude towards pressure ulcer prevention, but did not equate to possessing knowledge of pressure ulcer prevention Conclusion: The findings of this study suggest that fourth-year undergraduates have a positive attitude but lack adequate knowledge on the prevention of pressure ulcers Declaration of interest: There were no external sources of funding for this study The authors have no conflicts of interest t

Abstract: Burn injuries have a consistently high rate of mortality and morbidity, principally due to sepsis and systemic inflammation. Furthermore, wound closure is often troubled by a limited supply of autologous skin graft availability. Researchers are now looking at augmenting alternative sources for tissues engineering, including stem cells in the bone marrow, fat and hair follicles. Many studies suggest that the ability of stem cells to augment the clinical care of thermally-injured patients shows great potential; however, while our understanding of stem-cell biology has expanded dramatically over the last two decades, significant insight is still required so the full potential of these cells can be safely harnessed and transferred to patient care. This article provides a commentary on the evidence supporting a role for stem-cell therapy in acute burn care and tissue reconstruction, with particular reference to those in the bone marrow, adipose tissue and hair follicle.

Abstract: Objective:To investigate the hypothesis that stereophotogrammetric wound size monitoring shows suitable inter-observer reliability and user acceptance for clinical practice use. Method:Veterans admitted for conservative management of severe pressure ulcers were eligible for inclusion in the study. Three-dimensional (3D) digital wound images were independently captured by two expert and two non-expert nurse-observers using a commercially available stereophotogrammetry system, weekly for 6 weeks. A double-blinded analyst generated 3D wound reconstructions, using software to determine geometry. Clinical opinion of wound progression was provided by an expert physician. Results:Thirteen wounds were assessed with more than 80% of all images being readable. Interclass correlation of 0.9867 (p < 0.0001) was observed. Compared with clinical opinion, 3D wound measurement was sensitive between improving and static wounds for wound perimeter, volume, depth and length. Conclusion:These preliminary findings suggest tha...

Abstract: 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 gene...

Abstract: • Objective:To characterise the long-term course of epidermal regeneration in a suction-blister wound model in healthy humans. • Method:A single-centre, prospective cohort study was conducted. Suction blister wounds of 8mm diameter were created on the volar forearms of healthy volunteers. Planimetry was used to measure the wound surface area. tansepidermal water loss was estimated to characterise the skin barrier function. skin brightness was measured using the chromametric luminance L* parameter and skin (visco) elastic properties were measured by a controlled suction device. • Results:Thirty-two subjects (mean age 28.6 years) participated. Epithelisation was nearly completed after 8 days, but it took approximately 3 weeks for complete skin barrier restoration. Post-inflammatory hyperpigmentation was observed at the end of day 60 in the majority of skin areas. Elastic and viscoelastic deformation and recovery at the end of the follow-up period did not reach baseline values. • Conclusion:Newly formed epid...

Abstract: Objective: The treatment of open wounds with exposed bone, tendon, or nerve is a challenging reconstructive problem, especially in children. The purpose of this study is to evaluate the safety and effectiveness of using acellular dermal templates combined with negative pressure wound dressings in the treatment of complicated paediatric soft tissue extremity wounds. Method: A retrospective review of eight patients treated with acellular dermal templates for closure of complicated extremity wounds was performed. After debridement, all patients were treated with a template and a negative pressure wound treatment (NPWT) system. Results: The average age was 8.8 years with 4 females and 4 males. Four wounds were at the foot/ankle, with tendon exposed in all 4, nerve in 2, and bone in 3. There were 3 lower leg wounds, all with exposed bone. One patient had arm/hand wounds with exposed tendon. The size of the wounds and dermal graft averaged 86cm2 and 57cm2. The average time to wound closure was 65 days. The majo...

Abstract: Objective: To evaluate a community-based educational intervention to improve wound-care practice, and thereby reduce the costs of care, in four communities in Denmark. Method: Annual wound care audits recorded patients’ ages, the number and types of wounds being treated, wound duration (days unhealed), frequency of dressing changes and nurse time per dressing change. Data were available at year 1 and year 3 post-intervention. A statistical analysis was performed, testing for changes in a range of variables between these years. Results: In the post-intervention period, significant reductions were found in the proportion of chronic wounds, the proportion of wounds requiring a daily dressing change, mean frequency of dressing change, mean nurse time spent in wound care per week, and the total cost of wound care per week. Conclusion: These results suggest that it is possible to improve wound-care practice and reduce the resource costs of wound care through a systematic programme of education and training, tai...

Abstract: The technique of foam sclerotherapy directed at the distal most vessels, draining the ulcer bed was first described in 2010, with excellent penetration into the underlying venous network possible with this technique. Thirty-five patients have now been treated with this technique as the initial treatment at Midwest Vein Laser, USA. There have been no complications with this technique and rapid healing occurred within 4-8 weeks after the initial treatment in 90% of the patients, and all ulcers were healed at 4 months. Here we present the representative case of a 67-year-old man treated with a modified technique that used a percutaneous approach via reticular or spider veins at the margin of the ulcer bed.

Abstract: Non-healing wounds are a significant problem for health-care systems worldwide. In the industrialised world, almost 1-1.5% of the population will have a problem wound at any one time. Furthermore, wound management is expensive; in Europe, the average cost per episode is 6650 euros for leg ulcers and 10 000 euros for foot ulcers, and wound management accounts for 2-4% of health-care budgets. These figures are expected to rise along with an increased elderly and diabetic population.1-4.

Abstract: Routine care of non-healing acute and chronic wounds often comprises either cleaning or debridement. Consequently, debridement is a basic necessity to induce the functional process of tissue repair, which makes it a central medical intervention in the management of acute and chronic, non-healing wounds.

Abstract: • Objective:To provide a critical appraisal of nurses risk assessment and pressure ulcer (PU) preventive practices across scandinavia, Iceland and Ireland • Method:An integrative research review following Cooper's five stages Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU risk assessment or preventative practices, in any care setting, were included • Results:Risk assessment practice was primarily investigated in the acute care setting and was found to be irregular, based on both numeric scales and clinical judgments This irregular practice means that some vulnerable patients are not screened for pressure ulcer risk, conversely, when risk assessed, a care plan is not necessarily provided A significant gap in nurse documentation, together with a lack of supporting evidence for repositioning and use of appropriate redistribution devices was also identified, indicating a lack of a standardised approach to pressure ulcer prevention • Conclusion:Desp

Abstract: Objective: To investigate the effectiveness of an innovative electrical stimulation (ES) therapy as adjuvant treatment for chronic wounds of various aetiology, in terms of pain and ulcer healing. Method: Patients with chronic limb ulcers were enrolled for the study and randomised into the intervention or control group. The intervention group received conventional treatment plus ES therapy (FREMS; Lorenz Lifetech) while the control group received only conventional treatment. Each ES treatment cycle consisted of 12 sessions performed in 4 weeks (three sessions/week). All patients were treated until full wound healing occurred, or for a maximum of 9 ES cycles, with a 2-week rest between each cycle. Results: A total of 60 patients were enrolled in the study and randomised into the two groups: the intervention group (n=30) and the control group (n=30). During follow-up, some patients terminated the protocol because they reached the ulcer closure before the maximum of 9 cycles. The analysis of the effect of ES ...

Abstract: Objective: To quantify the extent to which patients disclose their concerns to community nurses during wound care consultations. Method: Using an ‘observation checklist’ based on themes and subthemes that were identified in a previous study of the same patients, 20 wound care consultations were observed. The non-participant observer completed the checklist and made field notes regarding the context and nature of interactions. Results: Patient participants had 160 opportunities to raise concerns regarding previously-identified pain, exudate and odour, yet they did not do so on 64 (40%) occasions. They had 28, 32 and 84 opportunities to raise emotional, wound care and daily living issues, respectively, and they did not on 16 (56%), 3 (9%) and 32 (38%) occasions. Overall, patients did not raise 38% of their concerns. Of the concerns that were raised, 8% were either not acknowledged or were disregarded by their community nurse. Conclusion: If these data are representative, this has profound implications for p...

Abstract: Objective: To assess feelings of powerlessness and hope for cure in patients with chronic venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). Method: A clinical, analytical, descriptive study was conducted from April to September 2012 in a wound-care clinic in Brazil, on consecutive patients presenting with VLUS and DFUS. The Powerlessness Assessment Tool for Adult Patients (PAT) and the Herth Hope Index (HHI) were used. Total PAT scores range 12–60 and the higher the score, the stronger the feelings of powerlessness. The HHI ranges 12–48, with higher scores indicating higher levels of hope Results: In total, 80 consecutive patients were recruited (40 VLU and 40 DFU). Mean PAT score was 53.3 ± 9.6 (range 21–60) for DFU patients and 34.3 ± 7.7 (range 21–60; p=0.001) for VLU patients, suggesting these individuals had strong feelings of powerlessness. The mean HHI was 16.5 ± 16.5 (range 12–40) for DFU patients and 27.5 ± 27.5 (range 12–40; p=0.001) for patients with VLUs, indicating low levels of hope....