Venous ulcers in Behçet syndrome

INTRODUCTION

Post-thrombotic syndrome (PTS) and stasis ulcers are late complications of deep vein thrombosis (DVT) in Behçet's syndrome (BS). We aimed to determine the clinical and histopathological characteristics, treatment modalities, and outcomes in BS patients with stasis ulcers.

METHOD

We included 63 BS patients with stasis ulcers from a total of 310 with vascular involvement, seen at a multidisciplinary center between January 2021 and July 2022. Data on demographics, clinical features, histopathology, radiology, and treatments were collected. Ulcer size, location, duration, and healing time were defined.

RESULTS

Patients' median age was 45 years, and age at vascular onset was 27 years. Except for 4 pts with only venous insufficiency, all had lower extremity DVT. Ulcers appeared a median of 3 years after vascular involvement onset and in 44 % healed imminently in a median of 6 months. At the time of evaluation in the current study, of the 63 patients with history venous ulcers, 35 (56 %) presented with active ulcers while the remaining presented with complete recovery of at least one-year duration. There were in total 202 ulcers with median ulcer size of 3 cm. 72 % were localized in the gaiter region. Histopathological examination was available for 21 pts. In 67 % (14/21), the diagnosis favored stasis dermatitis. No frank vasculitis was observed. Treatment included bed rest, local treatments, venous compression and immunosuppression. Patients received a combination of immunosuppressive agents, including biological DMARDs (75 %), non-biological DMARDs (97 %), and steroids (94 %). Despite these intensive therapies, ulcers remained unhealed in 17 %, and the recurrence rate was 73 % over a median follow-up of 16.8 years.

CONCLUSION

Leg ulcers are challenging complications of DVT in BS and represent an unmet medical need. Future studies should investigate the effectiveness of early immunosuppressive therapy, and other interventions in preventing venous ulcers and improving outcome.

Enhancing patient outcomes: the role of octenidine-based irrigation solutions in managing sore and irritated peristomal skin

This article explores the potential benefits of cleansing damaged peristomal skin with an octenidine-based antimicrobial irrigation solution.

Home-based nursing care for clients carrying multidrug-resistant organisms: A focus group study in the Netherlands

BACKGROUND

The growing population of vulnerable clients receiving home-based nursing care (HBNC), combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study explored the attitudes, perceptions, experiences, challenges, and needs of nursing staff providing HBNC for clients carrying MDROs.

METHODS

Seven focus groups with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semistructured, open-ended topic list based on the integrated-change model and seven domains of practice. Data were analyzed using thematic analysis.

RESULTS

Participants experienced ambiguities in infection prevention and control recommendations in MDRO guidelines or protocols. At times, the proportionality of these measures was questioned, including the effect on compliance. Participants indicated to be influenced by perceptions and behavior of their colleagues and clients. Furthermore, participants experienced inadequate information exchange about MDRO carriage and debated about the roles and responsibilities of involved health care professionals.

CONCLUSIONS

There is a need for tailored MDRO guidelines for HBNC. Expanding knowledge, sufficient resources, and improving information exchange about MDRO carriage among health care professionals, clients (including their family members), and HBNC organization boards are essential to respond to current developments in HBNC.

Beyond rheumatoid arthritis: A meta-analysis of the prevalence of anxiety and depressive disorders in rheumatoid arthritis

BACKGROUND

The prevalence of anxiety and depressive disorders in patients with rheumatoid arthritis (RA) is heterogenous with reports from 2.4 % to 85.2 % and 15 %-73.2 %, respectively. The present study provides meta-analytic current, and lifetime estimates of anxiety and depressive disorders amongst those living with RA.

METHOD

An online search of PubMed, PsycINFO, CINAHL, and WoS was conducted. Of the 3801 articles identified, 13 and 22 studies were coded for anxiety or depressive disorder prevalence in RA, respectively. Studies were included if they prospectively examined individuals (age >16) with RA, used semi-structured diagnostic interviews, and reported lifetime or current anxiety or depressive disorder comorbidity.

RESULTS

Data were analyzed using a Bayesian multilevel modelling approach, revealing current and lifetime prevalence of anxiety disorders to be 13.5 % CI95 % (9.2-17.3) and 22.2 %, CI95 % (15.9-29.1), respectively. Models also demonstrated the current and lifetime prevalence of depressive disorders to be 17.9 % CI95 % (10.1-27.1) and 32.4 %, CI95 % (18.3-47.6), respectively. Moderator analyses revealed numerically greater rates of GAD and MDD than other anxiety or depressive disorders.

LIMITATIONS

There were too few estimates to extensively model several moderators or to conduct exhaustive comparisons of demographic populations requiring greater representation such as males, non-White participants, and people with young adult RA onset.

CONCLUSIONS

The prevalence and risk for comorbid anxiety and depressive disorders in RA is extremely high. Routine screening and ongoing monitoring of individuals with RA for comorbid anxiety and depressive disorders is important to support improved prognosis.

Management of J-pouch Complications

Most patients with a restorative proctocolectomy with ileal pouch-anal anastomosis do well; however, properly identifying acute and chronic complications are paramount to managing and correcting these complications to allow for optimal pouch function and avoid pouch failure. Inflammatory conditions like pouchitis may require ongoing medical therapy, but surgical intervention may be needed to correct any underlying septic complication and to repair any structural disorders. Patients with signs of pouch failure may be candidates for pouch augmentation or redo pouch surgery and should be referred to high-volume centers before pouch excision is offered if the patient wishes to avoid a permanent ileostomy.

Safety and Effectiveness of a Fixed-Dose Combination of Trypsin, Bromelain, and Rutoside in Wound Management: A Randomized Clinical Trial

Background Wound healing following tissue injury is a precisely programmed biological process, typically occurring in a proper sequence and timeframe. While healing is perceived as inevitable, it heavily depends on tissue perfusion, which ensures oxygen and nutrient delivery, removal of waste, and promotion of cellular repair mechanisms. However, complications such as vascular occlusion due to fibrin or cellular debris, microbial contamination leading to infection, ischemic tissue necrosis, and dysregulated inflammation can impair healing. Proper care and repair are crucial to maintaining tissue perfusion and supporting the normal wound healing phases: reaction, regeneration, and remodeling. The use of oral enzymatic agents like trypsin, bromelain, and rutin offers a faster and more reliable method to support wound healing by reducing inflammation and enhancing tissue regeneration. This study was designed to assess the safety and effectiveness of treatment with Tibrolin® (a fixed-dose combination of trypsin 48 mg, bromelain 90 mg, and rutoside 100 mg tablet) in improving wound healing and alleviating acute pain in patients following uncontaminated surgeries. Methods A phase-IV, open-label, prospective, multi-center clinical study was conducted on 200 patients after elective, clean, uncontaminated surgery. Patients were randomized (1:1) to receive either Tibrolin® or Chymoral Forte® (trypsin-chymotrypsin) tablets, administered as two tablets to be taken orally thrice a day for seven days postoperatively. The primary outcome measure was the percentage of patients reporting incidences of adverse events, while secondary outcome measures were the mean change in the individual and total score of surgical wounds and the Numerical Pain Rating Scale (NPRS) score from baseline (day 0) to day 7. Results Tibrolin® was well-tolerated in the study, with no observed adverse or treatment-related adverse events. At the end of the treatment regimen, all wound healing parameters, including erythema, edema, discharge, induration, local irritation, and tenderness, showed a highly significant improvement (p < 0.001) in both treatment groups. Additionally, there was more than an 85% reduction in NPRS scores reported in both groups. A non-significant difference between groups in pain reduction (p = 0.737) and wound healing symptoms (p = 0.554) confirms that Tibrolin® is as efficacious as trypsin-chymotrypsin when evaluated on days 3, 5, and 7 of treatment. Tibrolin® tablets were regarded as good to excellent for treating wound symptoms by 87% of patients and 94% of investigators. Conclusion Our results suggest that Tibrolin® administration favors wound healing and improves wound symptoms, such as edema, inflammation, and pain in the management of elective clean, uncontaminated surgical wounds.

Precision emergency medicine in health care delivery and access: Framework development and research priorities

BACKGROUND

The integration of precision emergency medicine (EM) into our conceptualization of the health care system affords the opportunity to improve health care access, delivery, and outcomes for patients. As part of the Society for Academic Emergency Medicine (SAEM) Consensus Conference, we conducted a rapid literature review to characterize the current state of knowledge pertaining to the intersection of precision EM (defined as the use of big data and technology to deliver acute care for individual patients and their communities) with health care delivery and access. We then used our findings to develop a proposed conceptual model and research agenda.

METHODS

We completed a rapid review of the existing literature on the utilization of big data and technology to ensure and enhance access to acute/unscheduled care for individual patients and their communities. Literature searches were conducted using Ovid MEDLINE, Embase.com, Cochrane CENTRAL via Ovid, and ClinicalTrials.gov in January 2023. Using the identified articles, we determined core domains, developed a framework to guide the conceptualization of precision EM in health care delivery and access, and used these to identify a research agenda.

RESULTS

Of the 815 studies identified for initial screening, 60 underwent full-text review by our technical expert panel and 21 were included in the evaluation. Core domains identified included expedited/personalized prehospital care, delivery to the right level of care, personalized ED care, alternatives to ED care/post-ED care, prediction tools for system readiness, and creation of equitable systems of care. A research agenda with four priority research questions was defined following identification of the core domains.

CONCLUSIONS

Precision EM includes consideration of the health care delivery system as a mechanism for improving access to emergency care using data-driven strategies. This provides a unique opportunity to use data and technology to advance systems of care while also centering patients, communities, and equity in these advances.

Assessing Skin Tear Knowledge Among Nurses: A Multicentre Cross-Sectional Survey

AIMS

To assess the knowledge of nurses in Chinese hospitals regarding skin tears, focusing on evaluating their understanding and proficiency in managing and preventing skin tears, exploring the impact of demographic and professional factors on their knowledge levels and identifying specific areas where additional training or education is needed.

DESIGN

This study is a multicentre cross-sectional survey conducted in the Henan province of China using a stratified cluster sampling method.

METHODS

The study utilised the Chinese version of the Skin Tear Knowledge Assessment Instrument (OASES) for evaluating nurses' knowledge levels based on a questionnaire comprising 22 questions on the online platform Wenjuanxing (www.wjx.cn). All questions had to be answered, with only one option selectable per question. Response validity was ensured by excluding questionnaires that showed a clear response pattern, were completed in under 60 s, or scored 0 points. Descriptive analysis, item-level analysis and multiple linear regression analysis were performed.

RESULTS

A total of 1675 clinical nurses participated in this study. Age was a significant factor influencing skin tear knowledge, with older nurses (age, 41-60 vs. 18-40 years) demonstrating higher knowledge scores. Additionally, female nurses exhibited higher average knowledge scores compared to male nurses. Further, different departments, education levels, job titles and having completed relevant courses significantly influenced skin tear knowledge among nurses. However, on multivariate analyses, we found that working in the intensive care unit, having a higher education background and job title and having studied courses on wound, ostomy or incontinence were independent factors influencing knowledge on skin tear, indicating the need for targeted educational interventions.

CONCLUSION

In conclusion, targeted educational interventions and continuous professional development are essential to bridge the identified knowledge gaps among nurses in Chinese hospitals regarding skin tear management.

REPORTING METHOD

The Strengthening the Report of Observational Studies in Epidemiology checklist guidelines were followed.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Enhancing nurses' knowledge and skills in skin tear management through targeted educational programmes could improve patient care quality, reduce the incidence of skin tears and promote better wound care outcomes in clinical settings.

IMPACT

This study addresses the problem of knowledge gaps in skin tear management among nurses. The main findings indicate varied understanding and significant factors influencing this knowledge. The research impacts nurses and patients in Chinese hospitals, emphasising the need for specialised training and professional development to improve skin tear management and patient care. No patient or public contribution.

Navigating fragmented services: a gender-based violence (GBV) critical feminist analysis of women's experiences engaging with health and social supports in three Canadian cities

BACKGROUND

Gender-based violence (GBV) remains a pervasive public health crisis with devastating impacts on women's health and well-being. Women experiencing GBV face considerable barriers accessing appropriate and timely health and social services. This study explored women's experiences with health and social services in three Canadian cities to understand critical challenges and strengths in service provision for women experiencing GBV.

METHODS

In-depth interviews were conducted with self-identifying women (n = 21) who had accessed health or social care services and with service providers (n = 25) in three Canadian cities between February 2021 and November 2022. Women's interviews focused on experiences engaging with services including what worked well, the challenges they faced, and their recommendations to enhance service delivery to women experiencing violence. Staff interviews focused on their experiences of providing services within their organization, and the strengths and challenges in providing services to women within their community. Data were analyzed using reflexive thematic analysis with a gender-based violence critical feminist lens.

RESULTS

We organized the findings into three interrelated themes. First our results show how the systems within which health and social services are organized, are not designed to meet women's complex needs, with rigid structures, siloed services, and stigmatizing cultures creating significant barriers. Second, the data illustrate how service providers support and empower women through practices such as providing key information, assisting with administrative tasks, offering material resources, and addressing discrimination through advocacy and accompaniment. Third, our findings demonstrate how building an effective working relationship characterized by trust, non-judgment, and collaboration is crucial for service engagement and women's overall well-being.

CONCLUSIONS

Findings illuminate critical public health challenges as women navigate fragmented services across multiple and siloed systems not designed to meet their complex needs. There is an urgent need for systemic change to create more integrated, responsive support systems for women experiencing GBV. This includes addressing underlying structures perpetuating gender inequities and violence. Facilitating safe access to holistic services that consider women's preferences is crucial. Effective working relationships built on trust, respect, and power-sharing are key to supporting women's agency and addressing their interconnected needs.

Effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil from 1980 to 2019

Falls in older adults are a major public health problem. This study aimed to estimate the effects of age, period, and birth cohort on fall-related mortality in older adults in Brazil and its geographic regions, by sex, from 1980 to 2019. We conducted an ecological time-series study using data on fall-related deaths in older adults extracted from Brazilian Mortality Information System. Poisson models were adjusted for sex and geographic region to estimate age-period-cohort effects. From 1980 to 2019, Brazil recorded 170,607 fall-related deaths in older adults, with 50.1% occurring in women. More than half of these deaths occurred in the age group of 80 years or older (55%) and in the Southeast Region (52%). We observed an increase in fall-related mortality rates across all age groups and regions, regardless of sex. There was an increased risk of death in all periods after the reference period (2000 to 2004) in all geographic regions and for both sexes. We also observed a gradual increase in mortality risk for men born before 1914 and after 1935 compared to the reference cohort (1930 to 1934). In contrast, we found a protective effect across all birth cohorts for women. There was a consistent increase in fall-related mortality risk among older people in Brazil, posing a public health challenge. The findings highlight the urgent need for implementing public health policies that promotes older adults' health and prevents fall risks to improve this population's quality of life.

What can we learn from 68 000 clinical frailty scale scores? Evaluating the utility of frailty assessment in emergency departments

BACKGROUND

Emergency departments (EDs) in England are under significant strain, with increasing attendances and extended wait times, affecting frail older adults. The clinical frailty scale (CFS) has been implemented as a tool to assess frailty in ED settings, but its reliability and predictive accuracy as a screening tool remain debated.

OBJECTIVE

To evaluate the use and variability of the CFS in EDs and its association with patient outcomes, including discharge rates, length of stay, readmission and mortality.

METHODS

A retrospective cohort study of ED attendances at two London (UK) hospitals from 2017 to 2021. Data included CFS scores, demographics, clinical observations and outcomes. Comparative statistics, logistic regression, Cox proportional hazards models and competing risk regression were applied to examine CFS predictive validity.

RESULTS

In a sample of 123 324 ED visits, CFS scores strongly correlated with adverse outcomes: e.g. for long-term mortality (n = 33 475, events = 8871), each CFS single-point increase was associated with a 25% increase in mortality risk (95% CI 1.23-1.26). CFS scores varied significantly between raters and across visits, median difference two levels (interquartile range 1-3). Intraclass correlation coefficient analysis showed that 33.1% of CFS score differences was attributable to between-patient differences, 15.4% to inter-rater differences, with 51.5% residual variance from non-frailty factors, such as acute illness severity.

CONCLUSION

The CFS is associated with crucial patient outcomes in the ED. Inter-rater variability and potentially confounding factors can limit its consistency. Automation to enhance CFS score reliability should be explored as a means to support proactive management.

Performance indicators on long-term care for older people in 43 high- and middle-income countries: literature review, web search and expert consultation

BACKGROUND

Long-term care (LTC) for older people is an area of focus for many health and social policies in high- and middle-income countries. Performance Indicators are used to provide national and subnational jurisdictions with insights to ensure quality of the provided LTC services for older people. Although LTC systems vary across jurisdictions, there is demand for internationally comparable indicators to support countries in monitoring LTC and facilitate mutual learning. The aim of this study was to provide an overview of indicators currently employed to monitor the performance of LTC systems and services in high- and middle- income countries and describe their key characteristics.

METHODS

A review of the literature in six scientific databases (literature review) and web searches of relevant sites across 43 selected countries (web search) was conducted. We asked country representatives from the Working Party on Health Care Quality and Outcomes of the Organization for Economic Cooperation and Development, where most of these countries are represented, to cross-validate the sources of information found (expert consultation). We then extracted and analysed the data from all obtained sources based on a predetermined set of characteristics.

RESULTS

The search of scientific databases yielded 12,960 records, from which forty papers were selected for inclusion. The scientific literature findings were complemented by 34 grey literature sources. In total, we identified performance indicators being used to monitor LTC systems and services across 29 national and subnational jurisdictions in 24 out of 43 countries. In total, 620 indicators were identified. All jurisdictions used indicators related to institutional LTC and 16 also used indicators on home care. The most frequently monitored structures, processes, and results were pressure ulcers, falls, use of restraints and pain management.

CONCLUSIONS

We identified LTC performance indicators currently being monitored in 29 jurisdictions across 24 countries. Many jurisdictions are monitoring similar structures, processes, and results. This presents an opportunity to develop internationally comparable LTC performance indicators based on existing efforts across countries.

Facilitators and barriers faced by community organizations supporting older adults during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, olderadult-focused community organizations played an essential role in supporting the wellbeing of older adults. Supporting older adults during this time required extensive modifications to existing programming but their adaptations during the COVID-19 pandemic are not well documented. The purpose of this study was to understand how older adult-focused community organizations adopted virtual delivery formats during the COVID-19 pandemic and their perspectives of the barriers and facilitators for organizations and older adults.

METHODS

To understand the changes that were made, we conducted a qualitative environmental scan of community-based services across British Columbia. Online searches were complemented by snowball sampling and key informant interviews. We identified 90 older adult-serving community organizations and interviewed 26. We used reflexive thematic analysis to understand the main strategies.

RESULTS

These community organizations described barriers related to older adults' wellbeing, information technology proficiency, and personal/organizational losses related to changes in program structure. Facilitators for virtual activities and events included inter- and intra-organizational collaboration, intrinsic qualities of program design, physical resources to supporting virtual programming, and availability of technological resources. Organizations described meeting the challenge by increasing the 'depth' and 'breadth' of their reach.

CONCLUSION

Older adult-focused community organizations recognized the critical role they played for older adults and adapted their resources to meet those needs. Informational technology was quickly and effectively leveraged to promote social interaction for older adults when physical distancing was required during the COVID-19 pandemic. Barriers related to cost, time, and ultimately older adults' interest in a virtual delivery format were critical limitations.

Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review

BACKGROUND

Midwifery continuity of care during pregnancy, childbirth, and postpartum is essential for improving maternal and neonatal health outcomes. In low- and middle-income countries (LMICs), however, challenges such as healthcare worker shortages, limited infrastructure, poor healthcare access, and cultural barriers often hinder the effective provision of midwifery services. These issues contribute to unsustainable and inadequate care, adversely affecting maternal and newborn health. This study examines the impact of these challenges on the midwifery continuity of care and its subsequent effect on maternal and neonatal outcomes.

METHODS

A scoping review was conducted following Arksey and O'Malley's framework. We analyzed 43 articles published between 1932 and 2023 across four databases. Included studies were conducted in LMICs, focused on continuous care models, and published in English. The review aimed to capture the varied impacts of midwifery care on health outcomes.

RESULTS

The review found that midwifery continuity of care in LMICs significantly improves maternal and newborn health by reducing medical interventions, increasing physiological births, and enhancing maternal satisfaction and breastfeeding rates. The approach also lowers newborn mortality and morbidity. Success factors include community acceptance, midwives' cultural competence, and collaboration with traditional birth attendants. Barriers such as insufficient funding and resistance to change persist. Midwife-led continuity of care (MLCC) was associated with a 16% reduction in neonatal loss and a 24% reduction in pre-term births. Also, MLCC decreases newborn mortality by 10-20% and increases breastfeeding rates by up to 30%. Effective implementation requires integrating midwifery services into existing health systems, securing funding, expanding training, and strengthening community partnerships.

CONCLUSIONS

Midwifery continuity of care enhances maternal and neonatal health in LMICs by minimizing unnecessary medical interventions and improving maternal satisfaction and breastfeeding outcomes. However, cultural and socioeconomic factors influence its acceptance. Further research is needed to integrate traditional birth attendants into formal health systems, overcome resistance to change, and develop strategies for effective collaboration between traditional and professional care providers.

Comparison of ezetimibe and atorvastatin versus atorvastatin alone on short-term major adverse cardiac events after percutaneous coronary intervention, a double-blind placebo-controlled randomized clinical trial

BACKGROUND

Major cardiovascular events (MACE) after percutaneous coronary intervention (PCI) are among the most common causes of death in patients. Lipid-lowering strategies seem to affect these events. Reaching the best regimen for controlling lipid abnormalities is important. This study aimed to compare the effect of ezetimibe and atorvastatin versus atorvastatin alone in short-term major cardiovascular events in patients after PCI in Bandar Abbas in 2018.

METHODS

This double-blinded randomized controlled trial was done in Bandar Abbas in 2018 on 224 patients. Patients were randomly divided into two groups either to receive ezetimibe and atorvastatin (group A) or atorvastatin alone (group B). Patients were followed for 1 month for major cardiovascular events and drug side effects. Data was analyzed using SPSS software.

RESULTS

Patients in the two groups had similar baseline characteristics. The mean low-density lipoproteins (LDL) level was 69.83 ± 28.8 in group A and 82.45 ± 29.9 in group B (P = 0.014). At the end of the study, high-sensitivity C-reactive protein (hs-CRP) values were notably lower in group A (P value = 0.005). Three (2.7%) patients in group A and 1 patient (0.9%) in group B had a myocardial infarction (P value = 0.313). Also, 11 patients (9.8%) in group A and 13 patients (11.6%) in group B had unstable angina (P value = 0.666). No patients had death, cerebrovascular event, or stent thrombosis in the two groups.

CONCLUSION

Although adding ezetimibe to atorvastatin can decrease LDL and hs-CRP levels in short-term follow-up; it is not effective in lowering short-term major cardiovascular events in patients after PCI. Studies with longer-term follow-up are recommended.

TRIAL REGISTRATION

IRCT, IRCT20171028037047N1. Registered on 22 June 2018, https://irct.behdasht.gov.ir/trial/28808 .

Group reminiscence therapy interventions in non-clinical older adults: A systematic review

Reminiscence therapy has gained significant attention in the last decade, supporte1d by increasing evidence of its efficacy in enhancing psychosocial functioning in different populations. However, questions remain regarding this therapy, particularly about the feasibility of developing successful therapeutic interventions for non-clinical older adults. This systematic review aimed to provide evidence on the intervention contents of experimental studies using group reminiscence therapy in elderly individuals. A descriptive systematic review design was applied using the Web of Science database. Out of the 127 studies reviewed, only 26 examined reminiscence therapy interventions with non-clinical older adults. These studies revealed evidence regarding the positive impacts of reminiscence therapy on mental health and well-being outcomes, including depression, anxiety, stress, life satisfaction, happiness, and general health. Overall, the existing literature on the efficacy of reminiscence therapy in older adults is limited and much more research is required to understand the therapeutic interventions in this population.

Effectiveness of Advanced Practice Nursing Interventions on Diabetic Patients: A Systematic Review

Background: Diabetes mellitus is a complex chronic condition requiring continuous healthcare. Consequently, various organisations recommend therapeutic education to enhance treatment adherence. This is often facilitated by Advanced Practice Nurses, who provide a range of advanced interventions that impact clinical health outcomes and deliver healthcare services to these patients. Objective: To analyse the effectiveness of interventions performed by Advanced Practice Nurses in patients with diabetes. Method: A peer-reviewed systematic review was conducted and registered in PROSPERO. The databases consulted included PubMed, Scopus, Web of Science, and CINAHL. Inclusion criteria comprised studies published between 2014 and 2024 on the effectiveness of interventions by Advanced Practice Nurses in diabetic patients. The review included qualitative, quantitative, and mixed methods designs. Various screenings were carried out, including the assessment of methodological quality. Results: A total of 600 studies were identified, of which 17 were selected for final review. Among these, 12 studies focused on diabetic education. Interventions were predominantly delivered in person in primary care settings, private clinics, and hospitals. Reported outcomes included reductions in HbA1c levels, improved patient self-knowledge and self-efficacy, and decreased rates of readmission and mortality. Conclusions: The sample consisted predominantly of women over 60 years of age. Diabetic education emerged as the most common intervention, primarily delivered in person by Advanced Practice Nurses across diverse settings. Nearly all interventions proved effective in improving health outcomes for diabetic patients.

The renewed Development Model for Integrated Care: a systematic review and model update

BACKGROUND

Organising integrated health services beyond domains in interorganizational networks, can be supported by conceptual models to overview the complexity. The Development Model for Integrated Care (DMIC) is a systematically developed generic model that has been applied to innovate and implement integrated care services in a large range of (international) healthcare settings. After a decade, it is important to incorporate new available literature in the model. Therefore, our aim was to update and further develop the DMIC by incorporating the current body of knowledge.

METHODS

A systematic literature review and subsequent stepwise systematic update of the DMIC.

RESULTS

The review of the literature resulted in 179 included studies and eventually 20 new elements for the development model, which could be positioned in the nine clusters. New elements address the importance of the social system and community of the client, proactive care during the life span, digital (care) services and ethical and value driven collaboration in interorganizational networks that cross domains. The added elements for integrated care build further on the nine thematic clusters and the model as a whole, expanded with new accents.

CONCLUSION

The renewed model emphasizes the connectedness of care within a larger eco-system approach and inter-organizational networks. The model captures current knowledge which can be supportive as a generic conceptual model to develop, implement or innovate integrated services towards health value in societies. Further, it can serve for healthcare services research purposes to reflect on an monitor developments in integrated care settings over time on multiple levels.

Evaluation of the effect of manual lymphatic drainage method on edema, pain and trismus after impacted bilateral mandibular third molar surgery: a randomized clinical trial

BACKGROUND

The aim of this study was to evaluate the effect of manual lymphatic drainage (MLD) on edema, pain and trismus after impacted mandibular third molar surgery.

MATERIALS AND METHODS

46 patients with bilateral impacted mandibular third molar teeth were included in our study. The study was designed as a split-mouth, single-blinded, and controlled randomized clinical trial. Patients in the study group received MLD therapy, while the control group followed routine postoperative care including drug treatment. After extractions, the records were compared statistically and edema, pain and trismus parameters were evaluated on the 3rd and 7th days. The primary outcome variables was swelling and secondary outcome variables were pain and trismus. Swelling was evaluated using the 3dMD FACE SYSTEM (3dMD, Atlanta, GA). To assess pain, the Visual Analog Scale (VAS) was used and trismus was measured using with a digital caliper.

RESULTS

The present study was conducted on a total of 46 patients, aged between 18 and 26 years (18.7174 ± 1.50056), with bilaterally similar, symmetrical impacted mandibular third molars. The group consisted of 14 males (30.4%) and 32 females (69.6%). Postoperative edema, pain and trismus were found to be significantly lower in the MLD group compared to the control group (p < 0.05).

CONCLUSION

MLD technique is a useful method for reducing postoperative morbidity after impacted third molar extraction. The MLD technique is a simple method free from undesirable side effects and may be more effective than classical methods in reducing edema, pain and trismus after third molar extraction.

TRIAL REGISTRATION

The trial was registered retrospectively on ClinicalTrials.gov (ID: NCT06787027, on 22/01/2025). Approved by Izmir Katip Celebi University Clinical Research Ethics Committee (Decision No: ID 19, on 15/02/2018).

Factors influencing health-promoting lifestyle among medical personnel: a systematic review protocol

INTRODUCTION

A health-promoting lifestyle is essential for improving quality of life and reducing the risk of chronic diseases. However, despite their high health literacy, medical personnel often show low adherence to such lifestyles. Identifying the factors influencing these behaviours in medical professionals is critical for developing effective interventions. This review aims to identify the factors that influence the health-promoting lifestyle among medical personnel.

METHODS AND ANALYSIS

We will conduct a systematic search across three electronic databases: Web of Science, Scopus and PubMed. To ensure comprehensive literature coverage, we will also examine the reference lists of included studies and relevant reviews identified during the search. Eligible studies will include quantitative, qualitative and mixed-methods research articles that investigate factors influencing health-promoting lifestyles among medical personnel. No restrictions will be applied regarding geographical location or publication year. Only original, peer-reviewed journal articles published in English will be considered. The search strategy will incorporate key terms and their synonyms, including Medical Subject Headings terms such as 'factor', 'barrier', 'enabler', 'health-promoting lifestyle', 'medical personnel', 'doctor', 'nurse', 'medical technician', 'pharmacist' and 'hospital administrative staff.' All retrieved studies will be imported into Rayyan software for duplicate removal. Two independent reviewers will conduct the screening process based on predefined inclusion and exclusion criteria. The risk of bias in individual studies will be assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach will be employed to synthesise findings, categorising identified influencing factors into five levels of the Ecological Model of Health Behavior: intrapersonal, interpersonal, organisational, community and public policy levels.

ETHICS AND DISSEMINATION

Ethical approval is not required as no original data collection is involved. Findings will be disseminated via peer-reviewed journals, conferences and the primary author's PhD thesis.

PROSPERO REGISTRATION NUMBER

CRD42024579746.

Physical Activity, Taste Preferences, Selected Socioeconomic Characteristics: Differentiators of Consumer Behavior Among Older Adults in the Dairy Market in Poland-A Pilot Study

BACKGROUND

Dairy products contain many nutrients that are important for the human body, as they serve to maintain its physiological functions and protect against many diseases. Their consumption by older adults, however, raises certain doubts, including the risks of lactase deficiency, milk protein allergy, etc. Functional dairy products can help maintain or increase the consumption of dairy products among the elderly. This study aimed to evaluate the relationship between older adults' habitual purchases of dairy products and their taste preferences and frequency of buying functional dairy products, physical activity, and selected socioeconomic characteristics.

MATERIALS AND METHODS

This study was conducted between July and October 2024, among 310 people aged 60 and over in Poland. The study collected data on the frequency of buying dairy products (the PF-DP scale), preferences (the P_DP scale), physical activity (the IPAQ questionnaire), and socio-demographic and economic characteristics. The PCA identified three patterns of buying behavior. The relationship between the identified buying behavior patterns and their determinants was verified using the Kruskal-Wallis test and Chi-square.

RESULTS

It was found that high intensity of the "conventional dairy products and fats" pattern correlated with high taste preferences (Me = 8.0; p < 0.05), living with family regardless of whether with or without a partner (11.8% and 15.8%; p = 0.002), high physical activity (MET = 5975.5; p = 0.004), including movement (MET = 1803.0; p = 0.028), sports and recreational activities (MET = 1908.0, p = 0.017), and frequent purchases of different functional food groups. The financial situation described as "we have an average standard of living" was related to the high intensity of the "dairy fat" pattern (62.3%; p = 0.018) and its moderate intensity to the high activity associated with movement (MET = 1788.0; p = 0.004). More than half of the sample never purchased functional dairy products. A high intensity of the "conventional dairy products and fats" pattern was associated with more frequent purchases of functional products compared to other patterns.

CONCLUSIONS

The higher physical activity of older people was accompanied by a higher intensity of the "conventional dairy products and fats" pattern and more frequent purchases of functional dairy products. An evaluation of the relationships between the determinants and buying behaviors of older people in the dairy market, especially their causal nature, requires further research.

The Japanese Critical Care Nutrition Guideline 2024

Nutrition therapy is important in the management of critically ill patients and is continuously evolving as new evidence emerges. The Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024) is specific to Japan and is the latest set of clinical practice guidelines for nutrition therapy in critical care that was revised from JCCNG 2016 by the Japanese Society of Intensive Care Medicine. An English version of these guidelines was created based on the contents of the original Japanese version. These guidelines were developed to help health care providers understand and provide nutrition therapy that will improve the outcomes of children and adults admitted to intensive care units or requiring intensive care, regardless of the disease. The intended users of these guidelines are all healthcare professionals involved in intensive care, including those who are not familiar with nutrition therapy. JCCNG 2024 consists of 37 clinical questions and 24 recommendations, covering immunomodulation therapy, nutrition therapy for special conditions, and nutrition therapy for children. These guidelines were developed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by experts from various healthcare professionals related to nutrition therapy and/or critical care. All GRADE-based recommendations, good practice statements (GPS), future research questions, and answers to background questions were finalized by consensus using the modified Delphi method. Strong recommendations for adults include early enteral nutrition (EN) within 48 h and the provision of pre/synbiotics. Weak recommendations for adults include the use of a nutrition protocol, EN rather than parenteral nutrition, the provision of higher protein doses, post-pyloric EN, continuous EN, omega-3 fatty acid-enriched EN, the provision of probiotics, and indirect calorimetry use. Weak recommendations for children include early EN within 48 h, bolus EN, and energy/protein-dense EN formulas. A nutritional assessment is recommended by GPS for both adults and children. JCCNG 2024 will be disseminated through educational activities mainly by the JCCNG Committee at various scientific meetings and seminars. Since studies on nutritional treatment for critically ill patients are being reported worldwide, these guidelines will be revised in 4 to 6 years. We hope that these guidelines will be used in clinical practice for critically ill patients and in future research.

Expansion of the scope of nursing practice in community-based primary care: Addressing China's aging population and noncommunicable diseases with prescribing authority

This commentary addresses the urgent need to reform China's primary care system in response to its rapidly aging population and the increasing prevalence of noncommunicable diseases (NCDs). It advocates for a nurse-led primary care model within community healthcare centers, emphasizing the expansion of nursing roles. The analysis reviews nurse prescribing trials in Anhui, Sichuan, and Shenzhen, discussing their successes and limitations. Introducing the concept of community-based specialized nurses (CBSNs), it draws insights from South Africa's nurse-led practices in NCDs management practices. The goal is to modernize nursing role by advocating for expanded prescribing authority, enhanced regulation, and specialized qualifications. This commentary also explores how CBSNs can effectively operate within community settings nationwide to address the growing threat of NCDs among China's aging population. The proposed nurse-led model offers a transformative solution to China's healthcare system and sets a global precedent for addressing similar challenges in other nations.

Physiotherapy Intervention in the Immediate Postoperative Phase of Lipedema Surgery-Observational Study

Background: Lipedema is an adipose tissue disorder in women, with an abnormal fat deposition in lower limbs and occasionally upper limbs. The condition is characterized by pain, bruising, heaviness, and mobility impairment. Objectives: This study aims to evaluate the effects of a modified Complete Decongestive Therapy protocol using the Godoy Method in the postoperative period following lipedema surgery. Methods: In total, 293 participants who underwent liposuction for lipedema were studied. The postoperative physiotherapy protocol included Godoy cervical stimuli, Manual Lymphatic Drainage based on Godoy maneuvers, mechanical lymphatic drainage with RAGodoy®, compression with bandages, skin care, and therapeutic education. Results: This study found that the number of physiotherapy sessions significantly reduced pain (p = 0.000) and other complications (p = 0.007) and increased mobility (p = 0.003). The number of physiotherapy sessions showed significant differences in pain intensity at 90 days post-treatment (p = 0.000). In total, 47.24% of the participants became functionally independent on the third day of the physiotherapy intervention (p = 0.003). A total of 40.96% of the participants developed some complications, although a relationship between inadequate compression and the occurrence of complications was also found in 36.52% of patients. Conclusions: The success of surgical treatment for lipedema not only depends on the surgery itself but also on the proper management of the patient in the perioperative period to minimize complications and prevent recurrence. The Complete Decongestive Therapy protocol modified with the Godoy Method showed effects on pain reduction, mobility increase, edema reabsorption, and prevention of complications, consequently enhancing functionality and quality of life for patients undergoing lipedema surgery.

Clinical characteristics, comorbidities, and correlation with advanced lipedema stages: A retrospective study from a Swiss referral centre

INTRODUCTION

Lipedema is a chronic condition involving abnormal fat deposition in the lower limbs, often underdiagnosed, and poorly understood. We examined the epidemiological and clinical characteristics of a large patient cohort in Switzerland and their associations with disease severity.

METHODS

We included women aged 18 and over with lipedema at Lausanne University Hospital (CHUV), Switzerland. Demographic and clinical data, including disease type, stage, symptoms, and comorbidities, were collected. Descriptive statistics were used to summarise the data, and logistic regression was employed for analysis.

RESULTS

A total of 381 females (mean age 41.9 years) were included, mostly classified as type III (48.3%) and IV (30.2%) lipedema. In our population, 26.6% of patients were classified as stage 1, 44.5% as stage 2, and 28.9% as stages 3-4. Family history was reported in 49.9%, with symptoms often starting during adolescence (62.2%). Pain affected 87.9%, and quality of life (QoL) was significantly reduced, with 71.5% reporting low physical and 67.4% low mental well-being. Comorbidities were present in 92.1%, increasing with advanced disease stage, with chronic venous disease (86.2%) and obesity (51.7%) being the most common. Univariate analysis showed advanced lipedema was associated with age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 1.24, 95% CI: 1.19-1.29), and comorbidities (OR: 1.59, 95% CI: 1.39-1.81). Multivariate analysis confirmed age (OR: 1.06, 95% CI: 1.04-1.08) and BMI (OR: 1.22, 95% CI: 1.17-1.28) as correlates with disease stage.

CONCLUSIONS

Our study highlights frequent comorbidities in patients with lipedema, including chronic venous disease, obesity, and mental health conditions such as anxiety and depression. The distribution of comorbidities supports the need for tailored management. The correlation between disease stages, age, and BMI suggests potential progression, warranting confirmation through prospective studies.

Benchmarking vulvar cancer wound care practice in Australia and New Zealand: A cross-sectional study

PURPOSE

This study aimed to investigate current vulvar cancer wound care practices in Australia and New Zealand, identify knowledge of evidence supporting practice, explore enablers and barriers and determine areas for future improvement and research.

METHODS

An online cross-sectional survey collected quantitative and qualitative data from 64 nurses and doctors between May and July 2023. Descriptive statistics and content analysis were conducted. A consumer advisory group contextualised findings within lived experiences.

RESULTS

Common vulvar wound care practices included wound irrigation (n = 48, 83 %) and perineal drying (n = 40, 69 %), along with urinary catheters (n = 50, 86 %) and drains (n = 33, 57 %). Not using a wound dressing was common (n = 41, 71 %). Using silver (n = 25, 39 %), topical (n = 11, 17 %) or prophylactic (n = 2, 3 %) antibacterial agents were less common. Only 23 % (n = 15) of respondents reported knowledge of organisational guidance and care was commonly determined by practitioner preference, clinical assessment, and specialist wound nurse review. Reported enablers included guidance documents, clear instructions, clinician expertise, effective communication, and a well-informed patient. Reported barriers included infection, comorbidities, clinician variability, lack of evidence, systematic barriers, poor communication, and wound access challenges. The most common suggestion for improvement was the development of evidence based guidance. Four priority areas for future research were identified as; building an evidence base, evaluating the patient experience, investigating the impact of reducing risk factors and evaluating education interventions.

CONCLUSIONS

By benchmarking current wound care practices following surgery for vulvar cancer in Australia and New Zealand, priorities to direct future research and practice change efforts are supported.

Comparative Effectiveness of Active and Reactive Mattresses in Pressure Injury Healing for Older People in Their Own Homes: A Pragmatic Equivalence Randomised-Controlled Study

Background: Pressure injuries are an ongoing problem commonly managed with the prescription of pressure mattresses. There is conflicting research about the comparable effectiveness of the two types of pressure mattresses, active and reactive. This, coupled with technological advances and an updated understanding of pressure aetiology, means decision-making when prescribing pressure mattresses is complicated. Objective/Design: A pragmatic approach was used to design an equivalence randomised-controlled trial investigating the comparative effectiveness of active and reactive pressure mattresses in a community setting from a wound healing perspective as well as from a user acceptability perspective. Methods: Participants with an existing pressure injury were provided with an active or reactive mattress for wound healing, with wound stages assessed using photography. Usual clinical care was provided based on the protocols of the health care service, including nursing and occupational therapy input. Participants were monitored for the healing of their existing pressure injuries, using the Revised Photographic Wound Assessment Tool. User acceptability feedback was provided through surveys, including impact on comfort, pain levels and bed mobility. An equivalence design was used for data analysis to determine if the surfaces were comparable. Results: Twelve participants completed the study, which found that people on active mattresses healed 11.71 days (95% CI -55.97-31.78 days) quicker than people on reactive mattresses; however, the small sample size meant that a definitive determination could not be made. Users found bed mobility more challenging, and pain levels decreased, regardless of mattress type. Conclusions: A pragmatic methodology is imperative for research in this field due to the complexity of pressure injury healing. Researchers exploring multi-faceted conditions should consider a pragmatic design to ensure transferability of results to the clinical setting. The results from this study were inconclusive when determining the equivalence of active and reactive mattresses due to the small sample size. When choosing a mattress, prescribers need to consider user preferences and mattress features to ensure user acceptability.

Rapid in situ formation of a double cross-linked network hydrogels for wound healing promotion

The persistent challenge lies in accelerating wound healing. Bioactive hydrogels with in situ formation properties ensure that the dressing completely adheres to the wound and isolates it from external bacteria and microorganisms in order to meet the needs of damaged skin tissue for rapid hemostasis and wound healing. In this paper, hydrogel dressing that Polyacrylamide/Sodium alginate grafted with dopamine/Gelatin grafted with glycidyl methacrylate doped with Angelica sinensis polysaccharide was prepared (PDGA). Chemical cross-linking of PAAM by adding cross-linking agent to initiate free radical polymerization and photocross-linking by free radical polymerization of GMA-GEL under UV light irradiation are two cross-linking modes to construct dual-cross-linking network of PDGA hydrogel dressing. The hydrogel remains fluid when placed in a sealed syringe and solidify rapidly by photocross-linking when placed on the wound. Furthermore, the hydrogel demonstrated excellent biocompatibility and hematological safety. The interaction between angelica polysaccharides and integrins on the platelet surface facilitated an augmentation in platelet adhesion, activation, and aggregation, ultimately inducing rapid coagulation of the blood within 130 s in a mouse tail vein hemorrhage model. ASP can promote tissue healing by promoting cell proliferation around wounds and accelerating the formation of new blood vessels. In a mouse skin defect model, collagen deposition, blood vessel formation, hair follicle regeneration, and granulation tissue formation were observed due to the presence of angelica polysaccharides, showing significantly superior wound healing properties when compared to Tegaderm™ film. In addition, the expression of CD31 in skin wounds treated with PDGA was significantly upregulated. Consequently, PDGA multifunctional dressings exhibit considerable potential for in vitro hemostasis and skin wound repair applications.

Safety huddle in healthcare settings: a concept analysis

BACKGROUND

Safety huddles, brief interdisciplinary meetings aimed at proactive risk mitigation, are increasingly adopted in healthcare to enhance communication and patient safety. Despite their recognized benefits, inconsistent definitions, variable implementation, and conceptual ambiguity persist, hindering standardization and scalability. This study clarifies the concept of "safety huddle" through a rigorous concept analysis.

METHODS

Rodgers and Knafl's evolutionary concept analysis methodology was applied. A systematic search of CINAHL, Medline, and PubMed (2013-January 2025) identified 32 relevant studies. Data were analyzed to delineate core attributes, antecedents, consequences, and contextual variations of safety huddles.

RESULTS

Five core attributes emerged: (1) structured communication (e.g., SBAR, checklists), (2) interdisciplinary collaboration, (3) time-bound, goal-oriented design, (4) proactive risk prediction, and (5) contextual adaptability. Key antecedents included leadership support, psychological safety, and dedicated resources. Consequences encompassed enhanced teamwork, situational awareness, and safety culture. Contextual variations revealed adaptability across settings (e.g., maternity care, ICUs), though and inconsistent participation posed challenges.

CONCLUSIONS

Safety huddles are a dynamic, multifaceted intervention with significant potential to reduce medical errors and foster collaborative safety practices. However, conceptual inconsistencies and methodological gaps limit generalizability. Future efforts should prioritize standardized yet flexible frameworks, leadership training, and policy reforms to optimize huddle efficacy. This analysis provides a foundational model for advancing research, education, and practice in patient safety.

Comprehensive Geriatric Health Assessment Core Competencies and Skills for Primary Care Nurses: A Scoping Review

Objective: This scoping review aims to explore and synthesize the core competencies and skills required for primary care nurses conducting comprehensive geriatric assessments. Comprehensive geriatric assessments have become integral to providing holistic, patient-centered care for older adults with complex health needs, but the specific competencies required in primary care remain underresearched. Design: The review followed Arksey and O'Malley's five-stage scoping review framework, incorporating studies from PubMed, CINAHL, EMBASE, and the Cochrane Library. A comprehensive search was conducted from May 2014 to May 2024, and a population-concept-context (PCC) framework was used to identify relevant studies. Results: Nineteen studies met the inclusion criteria, revealing six key competency domains for nurses involved in comprehensive geriatric assessments: Clinical Assessment and Diagnostic Competencies, Care Planning and Coordination, Professional and Interpersonal Competencies, Environmental and Systemic Competencies, Technical and Procedural Competencies, and Quality Improvement and Evidence-Based Practice. These competencies are essential for providing high-quality care to older adults and supporting integrated, multidisciplinary approaches to geriatric care. Conclusions: The identified competency domains provide a structured framework that can enhance primary care nurses' ability to deliver more effective, individualized, and coordinated care to older adults. However, the standardization of these competencies remains crucial for ensuring consistency in practice.

Sustained-Release H2S Nanospheres Regulate the Inflammatory Microenvironment of Wounds, Promote Angiogenesis and Collagen Deposition, and Accelerate Diabetic Wound Healing

Diabetic wounds are blocked in the inflammatory stage, growth factors are degraded, and blood vessels are difficult to regenerate, leading to continuous necrosis and nonhealing of the wound. Hydrogen sulfide (H2S) plays an important role in the pathophysiological process of wound healing and has a long history of treating skin diseases. Although the sulfide salt solution is the preferred donor of exogenous H2S, its rapid release rate, excess production, and difficulty in accurately controlling the dose limit its use. Herein, we developed H2S sustained-release nanospheres NaHS@MS@LP for the treatment of diabetic wounds. NaHS@MS@LP nanosphere was composed of a NaHS-loaded mesoporous silicon core and a DSPE-PEG liposome outer membrane. When NaHS@MS@LP nanospheres were used to treat the wound of diabetic rats, mesoporous silicon was delivered into the cells and the loaded NaHS slowly released H2S through hydrolysis, participating in all stages of wound healing. In conclusion, NaHS@MS@LP nanospheres regulated the inflammatory microenvironment of wound skin by inducing the transformation of macrophages into M2 type and promoted angiogenesis and collagen deposition to accelerate wound healing in diabetic rats. Our findings provide strategies for the treatment of chronic wounds, including but not limited to diabetic wounds.

Prevalence of Poor Diet Quality and Associated Factors Among Older Adults from the Bagé Cohort Study of Ageing, Brazil (SIGa-Bagé)

(1) Background: The accelerated aging of the population raises concerns about the diet of older adults due to its relationship with health and quality of life. This study aimed to investigate the prevalence of poor diet quality and its association with sociodemographic factors and health status among older adults residing in the city of Bagé, located in southern Brazil; (2) Methods: A cross-sectional analysis was conducted using data from the 2016/2017 follow-up of the Bagé Aging Cohort Study (SIGa-Bagé). Diet quality was assessed using the Elderly Diet Quality Index. Descriptive analysis and Poisson regression with robust variance adjustment, based on hierarchical levels, were used to calculate crude and adjusted prevalence ratios with their respective 95% confidence intervals; (3) Results: The sample included 728 older adults (65.7% female; mean age: 77.2 years). Poor diet quality was observed in 41.5% of participants. After adjustment, male sex, black or brown skin color, absence of multimorbidity, and presence of depressive symptoms were significantly associated with poor diet quality; (4) Conclusions: The findings highlight the most vulnerable groups and the need for investments in strategies to promote mental health and healthy eating habits among the older adults, particularly among men and racial minority groups.

Characterization of a Bioactive Chitosan Dressing: A Comprehensive Solution for Different Wound Healing Phases

Wound management has made significant advances over the past few decades, particularly with the development of advanced dressings that facilitate autolytic debridement, the absorption of wound exudate, and protection from external bacteria. However, finding a single dressing that effectively addresses all four phases of wound healing─hemostasis, inflammation, proliferation, and remodeling─remains a major challenge. Additionally, biofilms in chronic wounds pose a substantial obstacle by shielding microbes from topical antiseptics and antibiotics, thereby delaying the healing process. This study evaluates the wound-healing properties of a commercially available bioactive microfiber gelling (BMG) dressing made from chitosan alongside commercially available silver-loaded carboxymethyl cellulose (CMC-Ag) dressing, carboxymethyl cellulose dressing (CMC) and cotton gauze. In vitro testing demonstrated that the BMG dressing significantly exhibited superior fluid absorption and exudate-locking properties compared with the CMC-Ag dressing. Additionally, the BMG dressing effectively sequestered and eradicated wound-relevant pathogenic microorganisms, including drug-resistant bacteria. Its bioactive properties were further highlighted by its ability to enhance platelet-derived growth factor (PDGF) expression and sequester matrix metalloproteases (MMPs). Overall, this study highlights the effectiveness of the BMG dressing in wound management, particularly in exudate absorption and antimicrobial activity, demonstrating its relevance in wound care.

Enhancing early diagnosis and monitoring of wound infections caused by multiple bacteria in tissues through digital PCR integration with cutaneous infection biomarkers

BACKGROUND

This study explores the potential of combining digital polymerase chain reaction (PCR) with cutaneous infection biomarkers for the early diagnosis and monitoring of wound infections caused by multiple bacteria.

METHODS

We selected a cohort of 276 patients with wounds who were admitted to our hospital from July 2022 to July 2023. These patients were categorized into 46 infection cases and 230 non-infection cases based on clinical evaluation. Clinical data, including routine blood tests [Red Blood Cell count (RBC), Hemoglobin (Hb), White Blood Cell count (WBC), Platelets (PLT)], D-dimer (D-D), and blood biochemistry parameters (liver function, lipid profile, blood glucose, renal function), were collected from both groups. Bacterial cultures were obtained from the infection group, and digital PCR targeting multiple bacteria (Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae) was performed. Logistic regression analysis was conducted to identify risk factors for wound infection, and receiver operating characteristic (ROC) curves were generated to assess the diagnostic performance of digital PCR in conjunction with cutaneous infection biomarkers.

RESULTS

No significant differences were observed between the infection and non-infection groups regarding age, gender, body mass index (BMI), or wound characteristics (P > 0.05). However, the infection group exhibited significantly higher levels of RBC, Hb, WBC, PLT, and D-D (P < 0.05). Key factors influencing wound infections included WBC, PLT, glycosylated hemoglobin, and the specific bacteria identified. ROC curve analysis revealed area under the curve (AUC) values for individual markers, with a combined AUC of 0.899, demonstrating excellent diagnostic performance.

CONCLUSION

Digital PCR, when combined with cutaneous infection biomarkers, proves to be an effective diagnostic tool for wound infections. This approach shows great promise in clinical applications, with the potential to significantly improve patient outcomes.

Detection of Acute Deterioration in Care Home Residents: A Multicenter Qualitative Exploration of Barriers and Enablers

INTRODUCTION

Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death.

OBJECTIVE

Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents.

STUDY DESIGN

Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis.

RESULTS

Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork.

CONCLUSION

Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes.

CLINICAL RELEVANCE

Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.

Factors influencing the choice of urethral slings over artificial sphincter for male stress urinary incontinence

OBJECTIVE

To examine the factors influencing urologists' decision to offer slings instead of AUS for managing male stress urinary incontinence.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006-2021 was used to identify patients undergoing surgical procedures for male urinary incontinence using current procedural terminology (CPT) codes. The Current procedural terminology (CPT) codes for AUS (53,445) and male slings (53,440) were used to analyze the data appropriately. The cases with incomplete demographic data were excluded. Patient characteristics of interest were race, age, smoking status, obesity, HTN, COPD, ASA classification, use of glucocorticoids, history of cancer, and diabetes mellitus. Chi square and multivariate logistic regressions were used to identify significant predictors of outcomes. Significance was defined as p<0.05.

RESULTS

Among 4098 patients, 2407 underwent AUS implantation, and 1691 received a sling for male SUI. African American males were significantly more likely than Caucasian males to receive a sling (OR = 5.566, p < 0.05). The patients with comorbidities such as diabetes mellitus, hypertension, use of glucocorticoids, cancer, increased ASA, and history of DVTs are significantly more likely to undergo sling placement. COPD, congestive heart failure, and dialysis had no impact on the choice of male urinary incontinence management.

CONCLUSION

Male patients who are African American or have comorbidities such as history of diabetes, hypertension, cancer, DVT, and glucocorticoid use were more likely to be offered slings for stress urinary incontinence. These findings suggest a preference among urologists to recommend slings for patients with higher surgical risk profiles.

Pelvic floor muscle training with feedback or biofeedback for urinary incontinence in women

BACKGROUND

Pelvic floor muscle training (PFMT), compared to no treatment, is effective for treating urinary incontinence (UI) in women. Feedback and biofeedback are additional resources that give women more information about their pelvic floor muscle contraction. The extra information could improve training performance by increasing capability or motivation for PFMT. The Committee on Conservative Management from the 7th International Consultation on Incontinence states that the benefit of adding biofeedback to PFMT is unclear. This review is an update of a Cochrane review last published in 2011.

OBJECTIVES

The primary objective was to assess the effects of PFMT with feedback or biofeedback, or both, for UI in women. We considered the following research questions. Are there differences in the effects of PFMT with feedback, biofeedback, or both versus PFMT without these adjuncts in the management of stress, urgency or mixed UI in women? Are there differences in the effects of feedback versus biofeedback as adjuncts to PFMT for women with UI? Are there differences in the effects of different types of biofeedback?

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023), which includes searches of CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP as well as handsearching of journals and conference proceedings, and the reference lists of relevant articles.

SELECTION CRITERIA

We included only randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs in women with UI. We excluded studies that recruited women with neurological conditions, who were pregnant or less than six months postpartum. Eligible studies made one of the following comparisons: PFMT plus feedback versus PFMT alone, PFMT plus biofeedback versus PFMT alone, PFMT plus feedback or biofeedback versus PFMT alone, PFMT plus feedback versus PFMT plus biofeedback, and one type of biofeedback versus another.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for eligibility, extracted data onto a prepiloted form, and assessed risk of bias using RoB 1. We used the GRADE approach to assess the certainty of evidence in each comparison by outcome. Our primary outcome was lower urinary tract symptom-specific quality of life. We pooled data using a standardised mean difference (SMD). Secondary outcomes were leakage episodes in 24 hours (mean difference (MD)), leakage severity (MD), subjective cure or improvement (odds ratio (OR)), satisfaction (OR), and adverse events (descriptive summary).

MAIN RESULTS

We included 41 completed studies with 3483 women. Most (33 studies, 3031 women) investigated the effect of PFMT with biofeedback versus PFMT alone. Eleven studies were at low risk of bias overall, 27 at unclear risk of bias, and three at high risk. Only one study reported leakage severity, with no usable data. Comparison 1. PFMT with feedback versus PFMT alone: one eligible study reported no outcome of interest. Comparison 2. PFMT with biofeedback versus PFMT alone: there was little or no difference in incontinence quality of life (SMD 0.07 lower, 95% confidence interval (CI) 0.18 lower to 0.05 higher; 11 studies, 1169 women; high-certainty evidence). Women randomised to biofeedback had 0.29 fewer leakage episodes in 24 hours versus PFMT alone (MD 0.29 lower, 95% CI 0.42 lower to 0.16 lower; 12 studies, 932 women; moderate-certainty evidence), but this slight reduction in leakage episodes may not be clinically important. Women in biofeedback arms report that there is probably little to no difference in cure or improvement (OR 1.26, 95% CI 1.00 to 1.58; 14 studies, 1383 women; moderate-certainty evidence) but may report greater satisfaction with treatment outcomes (OR 2.41, 95% CI 1.56 to 3.7; 6 studies, 390 women; low-certainty evidence). None of these outcomes were blinded. Eight studies (711 women) assessed severe adverse events but reported that there were no events. Comparison 3. PFMT with feedback or biofeedback versus PFMT alone: a single study contributed very-low certainty evidence regarding leakage episodes in 24 hours, subjective cure or improvement, and satisfaction. Comparison 4. PFMT with feedback versus PFMT with biofeedback: the evidence is very uncertain about any difference in effect between biofeedback versus feedback for incontinence-related quality of life. Not only is the evidence certainty very low, the confidence interval is very wide and there could be a more than small effect in favour of biofeedack or feedback (SMD 0.14 lower, 95% CI 0.56 lower to 0.28 higher; 2 studies, 91 women; very-low certainty evidence). There may be fewer leakage episodes in 24 hours for women receiving biofeedback verus feedback but the difference may not be clinically important and the evidence certainty is low (MD 0.28 lower, 95% CI 0.62 lower to 0.07 higher; 2 studies, 120 women; low-certainty evidence). There were no data for subjective cure, improvement or satisfaction. One study measured adverse events and none were reported. Comparison 5. PFMT with biofeedback versus PFMT with another type of biofeedback: five studies assessed this comparison, with individual studies contributing data for separate outcomes. There was low- or very-low certainty evidence about the benefits of one type of biofeedback versus another for leakage episodes in 24 hours or subjective cure or improvement, respectively. One study reported adverse events from two of nine women receiving electromyography biofeedback versus six of 10 receiving pressure biofeedback.

AUTHORS' CONCLUSIONS

PFMT with biofeedback results in little to no difference in incontinence quality of life. The addition of biofeedback to PFMT likely results in a small unimportant difference in leakage episodes in 24 hours, and likely little to no difference in patient-reported cure or improvement. Satisfaction may increase slightly for PFMT with biofeedback, based on low-certainty evidence. Five of the 33 studies in this comparison collected information about adverse events, and four reported none in either group. Adverse events reported by women using biofeedback seemed related to using a vaginal or rectal device (e.g. discomfort with device in place, vaginal discharge). The other comparisons had few, small studies, and low- to very low-certainty evidence for all outcomes. None of the studies reported any severe adverse events.

The impact of an educational discharge program based on Orem's self-care model on lifestyle, hope, and treatment adherence in coronary angioplasty patients: a randomized controlled clinical trial

OBJECTIVE

Patient education at the time of discharge using models which aim to improve self-care behaviors can significantly contribute to patients' adoption of a healthy lifestyle and treatment adherence. This is a randomized controlled clinical trial with no blinding in which we tested two groups of intervention control. 90 patients having undergone coronary angioplasty were allocated to an intervention (N = 45) and a control group randomly (N = 45). Data were collected from January to October 2022. The data collection instruments comprised angioplasty patients' treatment adherence questionnaire, Walker's health-promoting lifestyle profile questionnaire, and Snyder's Hope Scale. Data analysis was performed using SPSS version 23. To analyze the data, we used descriptive statistics. Accordingly, inferential statistics applied included chi-square, independent-samples t-test, and repeated measures (ANOVA). Significance level was considered as p < 0.05.

RESULTS

The mean scores of lifestyle, hope, and treatment adherence in the intervention group were significantly higher than those of the control group as measured immediately and three months after the intervention (p < 0.05). The study results revealed that using discharge program based on Orem's self-care model positively impacted the lifestyle, hope, and treatment adherence of patients having experienced coronary angioplasty.

IRANIAN REGISTRY OF CLINICAL TRIALS

IRCT registration number: IRCT20190917044802N5.

REGISTRATION DATE

17/7/2022.

What are the experiences and support needs of district nurses caring for terminally ill people with delirium at home? A qualitative study

BACKGROUND

Delirium is a serious neuropsychiatric syndrome, which is common amongst terminally ill people in the community. District nurses have a key role in supporting terminally ill people to remain at home.

OBJECTIVES

To explore the experience and support needs of district nurses caring for people with delirium in home settings.

METHODS

Semi-structured individual and small group interviews were conducted via Microsoft Teams with 12 district nurses in Scotland, UK. Data was analyzed using framework analysis. Data was coded both deductively and inductively.

RESULTS

Overarching themes were (i) challenges of delirium detection in the community, (ii) challenges managing delirium in the community, (iii) family carers as providers and recipients of care and (iv) education, training and support needs. Participants valued clinical judgement alone in detecting delirium, over use of formal assessment tools. Patients were referred to district nursing services at an advanced stage of their illness, with nurses needing to make rapid decisions about their care, sometimes with limited information. Participants were familiar with non-pharmacological strategies and the importance of family carer support, but uncertainty remained regarding pharmacological management of distressing symptoms. The term 'delirium' was rarely used. Challenges accessing timely advice and practical support from other health and social care professionals were reported. Participants identified delirium detection and the pharmacological management of persistent delirium as priorities for training.

CONCLUSION

Caring for terminally ill people with delirium in the community is challenging. Educational interventions may be beneficial in developing district nurses' confidence in supporting terminally ill patients and their families. Responsive advice and support are required from specialist palliative care services.

Spatiotemporal single-cell roadmap of human skin wound healing

Wound healing is vital for human health, yet the details of cellular dynamics and coordination in human wound repair remain largely unexplored. To address this, we conducted single-cell multi-omics analyses on human skin wound tissues through inflammation, proliferation, and remodeling phases of wound repair from the same individuals, monitoring the cellular and molecular dynamics of human skin wound healing at an unprecedented spatiotemporal resolution. This singular roadmap reveals the cellular architecture of the wound margin and identifies FOSL1 as a critical driver of re-epithelialization. It shows that pro-inflammatory macrophages and fibroblasts sequentially support keratinocyte migration like a relay race across different healing stages. Comparison with single-cell data from venous and diabetic foot ulcers uncovers a link between failed keratinocyte migration and impaired inflammatory response in chronic wounds. Additionally, comparing human and mouse acute wound transcriptomes underscores the indispensable value of this roadmap in bridging basic research with clinical innovations.

Effects of the Chinese traditional fitness practice Wuqinxi on balance improvement in older women with a history of falls: a randomized controlled trial

Objective

This study evaluated the impact of Wuqinxi Qigong, a traditional Chinese fitness practice, on the balance abilities of older women with a history of falls.

Methods

Participants in the experimental group (n = 35) and the control group (n = 36), matched for age, height, and weight, engaged in a 24-week Wuqinxi exercise program (three times per week, 70 min per session). Dynamic and static balance abilities were assessed at weeks 0, 12, and 24.

Results

Within the experimental group, compared to baseline, the movement distance of the center of pressure with open eyes (left and right) decreased by 17.0 and 22.1% at weeks 12 and 24, respectively (p < 0.05). The movement distance with closed eyes, the total length of displacement of the center of pressure, and the speed of center of pressure (left and right) decreased by 17.1, 8.6, and 16.6% at week 24 (p < 0.05). The one-leg stand time with eyes open and closed increased by 47.7, 68.0, and 77.1%, 80.6% at weeks 12 and 24, respectively (p < 0.01). Compared to week 12, the one-leg stand time with eyes open increased by 19.9% at week 24 (p < 0.01).

Conclusion

A 24-week Wuqinxi exercise regimen enhances both static and dynamic balance abilities in older women with a history of falls. A longer regimen further improves static balance with eyes open compared to the 12-week mark.

Application of pressure injury preventive measures and bundles in home and community environments: a scoping review protocol

INTRODUCTION

Several studies have addressed the use of pressure injury preventive measures and bundles for hospitalised patients. However, there is a gap in research regarding the use of pressure injury preventive measures and bundles in the home environment. This scoping review aims to identify, explore and map the international literature on pressure injury preventive measures and bundles in the home and community environments.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the reporting of this scoping review. The Joanna Briggs Institute guide will inform the methods. A modified version of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols will be used to guide the reporting of this scoping review protocol. An initial search was carried out in July 2024. The search will be conducted in electronic databases such as LILACS, SciELO, Scopus, PubMed, Embase, CINAHL, Cochrane Library and Web of Science. The search will be restricted to studies in English, Portuguese and Spanish, with no time restriction. Additional literature will be retrieved by reviewing the reference lists of the selected studies based on their titles. Two independent reviewers will carry out the data extraction process. Essential details, including the author, references and findings pertinent to the review questions, will be collected. The findings will be displayed through graphs, tables and figures, supplemented by a narrative summary.

ETHICS AND DISSEMINATION

As this review will be conducted using secondary data, ethical approval is not required. Results will be shared with the international scientific community through conference presentations and publication in a high-impact journal.

STUDY REGISTRATION

This scoping review was registered with the Open Science Framework registry (osf.io/m5gvn) on 8 August 2024.

Recognising and addressing loneliness and social isolation in older people

Loneliness is widely recognised as a problematic issue in UK society. Older people are particularly vulnerable to loneliness and social isolation for various reasons, and the effects of these can be detrimental to their physical and mental health and well-being. Recognising the signs and symptoms associated with loneliness and social isolation is central to beginning the process of assessment and intervention. This article describes the concepts of loneliness and social isolation and explores their link to physical and mental health. The author also discusses some ways in which nurses can measure loneliness and provides some examples of interventions, such as health coaching and social prescribing, which can help to reduce the experiences of loneliness and social isolation in older people.

How to administer a percutaneous endoscopic gastrostomy (PEG) feed

RATIONALE AND KEY POINTS

In hospitals and nursing homes, the maintenance of feeding tubes used in enteral nutrition, such as percutaneous endoscopic gastrostomy (PEG) (the placement of a feeding tube directly into the stomach through the abdominal wall), is often a nursing responsibility. Therefore, it is vital nurses understand how to care for this patient group safely and effectively. Incorrect PEG procedures, inadequate infection prevention and control practices, and a lack of appropriate stoma care, can negatively affect patient outcomes. Nurses administering enteral feeding via PEG must have the knowledge and skills required to do so safely and must work within their level of competence. • Enteral nutrition such as PEG aims to meet the nutritional requirements of patients who have an intact gastrointestinal (GI) tract but whose oral intake is inadequate. • Management of the PEG feeding tube and care of the stoma site are vital, and nurses should be able to recognise common complications of PEG feeding. • A non-touch technique should be used when administering enteral feed via PEG to reduce the risk of bacterial contamination. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when administering enteral feed via PEG. • How you could use this information to educate nursing students or colleagues about safe enteral feeding with PEG.

Perceptions and satisfaction with the quality of clinical training placements among nursing and midwifery students in Northern Ghana

BACKGROUND

Clinical teaching and learning empower students to translate classroom learning into patient care, facilitating their evolution into competent nurses and midwives. Developing competent nurses is crucial for enhancing the quality of the healthcare system, necessitating quality nursing education to equip them with the required knowledge and skills. The quality of clinical placements significantly influences how students acquire skills, knowledge, and clinical reasoning, as well as how they develop as professional nurses and midwives. However, significant research gaps exist in assessing the quality of clinical placements among student nurses and midwives in Northern Ghana.

AIM

The current study aimed to evaluate the perceptions and satisfaction levels of student nurses and midwives regarding the quality of clinical training placements in Northern Ghana.

METHODS

The study adopted a multi-center, descriptive cross-sectional design. A structured questionnaire was used to collect data from the respondents. Proportionate sampling was used to determine the number of respondents per institution. Respondents were selected to participate in the study using a simple random sampling technique. Data were analysed using SPSS Statistics Version 27. Descriptive statistics were used to summarize the results in frequencies, percentages, means, and standard deviations. Hypothetical relationships between students' perceptions of clinical training quality, satisfaction, and demographics were tested using One-way ANOVA, t-tests, and Pearson correlation. Tukey LSD post hoc analysis assessed pairwise differences, and statistical significance was pegged at P < 0.05.

RESULTS

Overall, students had a good perception (M = 4.01, SD = 0.87) and satisfaction (M = 6.93, SD = 1.94) with their clinical training placement quality. The majority of respondents (92.2%) strongly agreed or agreed with the statement "This placement was a good learning environment", whereas 72.0% strongly agreed or agreed with the statement "I received regular and constructive feedback". Both One-way ANOVA and the independent sample t-test indicated that diploma level (p = 0.008) and the educational institution attended (p < 0.001) had a significant impact on how students perceived the quality of their clinical training placement. Also, there was a significant positive correlation between perceptions of the quality of clinical training placement and satisfaction with clinical training placement among the students (r = 0.65, p < 0.001).

CONCLUSION

Students generally had good perceptions of their clinical placements and were moderately satisfied with their clinical training placements. However, there are also clear differences in the quality of clinical placements amongst the educational institutions in Northern Ghana. Clinical placement settings and academic institutions should collaborate to examine and develop specific teaching methods, supervision approaches, and learning frameworks that can improve clinical learning and teaching among students.

TRIAL REGISTRATION

This is not applicable.

NO PATIENT OR PUBLIC CONTRIBUTION

No patients or members of the public were involved in setting the research objectives, designing the study, analyzing or interpreting the data, or preparing the manuscript. Nursing and midwifery students from five colleges in Ghana's Northern, Savannah, and Northeast regions answered the research questionnaire.

Silver sulfadiazine therapy for the management of burns

BACKGROUND

Burns are a significant global public health concern. There are approximately 180 000 burn-related deaths annually. This review analysed the characteristics of silver sulfadiazine (SSD) therapy and its effectiveness in treating moderate and severe burns.

METHOD

This is a systematic review of studies published between 2018 and 2023, conducted using Google Scholar, PubMed and Science Direct. The search identified 4155 articles; 3708 were excluded based on titles and abstracts. After further screening, 10 full-text articles were analysed, including five randomised controlled trials, one cross-series study, one cross-sectional study and three experimental studies.

FINDINGS

The analysis indicated that SSD therapy is effective for second- and third-degree burns. Eight studies reported positive outcomes such as enhanced healing, granulation tissue formation and infection control. However, two studies noted limited effectiveness, highlighting the need for complementary treatments to optimise results. No severe complications were associated with SSD use, demonstrating its safety and reliability in burn care.

CONCLUSIONS

SSD therapy is an effective and safe option for managing moderate and severe burns, often requiring additional treatments to maximise its benefits.

IMPLICATIONS FOR PRACTICE

SSD therapy should be incorporated into burn treatment protocols, with additional therapies considered to enhance healing outcomes. Its effectiveness in infection control makes it a valuable option, particularly in resource-limited settings where advanced treatments may not be available. To optimise burn management, ongoing research and clinician training are essential in refining best practices and ensuring the most effective use of SSD therapy.

Distinctive features of district nursing in contrast to nursing in other settings: a discussion

Effective retention strategies are essential for the sustainability of district nursing services. To develop tailored retention strategies, the authors of this article examine what makes district nursing different compared to hospital and other care settings. Based on literature reviews and discussion groups, the authors identify five key characteristics of district nursing. This article invites expert district nurses to review these characteristics and provide feedback. By clearly identifying the distinctiveness of district nursing, the authors aim to strengthen retention strategies and explore other potential benefits for services.

Reducing variance in wound care: a cross-sectional study of chronic wounds in one district nursing team's caseload

BACKGROUND

Pressure ulcers, leg ulcers and slow-healing surgical wounds are the most prevalent chronic wounds. Variance in care of such wounds has frequently been documented in the literature. This study investigated the local landscapes for such variance.

AIM

This article discusses the findings of a cross-sectional study of variance in care of chronic wounds, undertaken with one district nursing team's caseload in a large city in the North East of the UK.

METHODS

The workload of one district nursing team (n=6 staff) was examined over a 2-week period using electronic records. Where variance was identified, patients were visited at their home by a tissue viability nurse for further investigation.

RESULTS

Thirty-four patients with chronic wounds were reviewed. While pressure ulcers and slow-healing postoperative wounds were treated according to standard guidance, there was significant variation in the care of leg ulceration in all patients.

CONCLUSIONS

This study supports the view that there is variance in wound care, and reducing this variance and optimising wound care should be prioritised. This could be achieved by increasing input from tissue viability services.

IMPLICATIONS FOR PRACTICE

Implementing standardised protocols based on best practice guidelines could improve consistency and outcomes in wound care. The increased involvement of tissue viability nurses in wound assessments and care planning could help reduce variance in care.