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Chen A, Dusza S, Bromberg J, Goldfarb S, Sanford R, Markova A. Quality of Life in Patients with Malignant Wounds Treated at a Wound Care Clinic. RESEARCH SQUARE 2024:rs.3.rs-4797536. [PMID: 39281876 PMCID: PMC11398584 DOI: 10.21203/rs.3.rs-4797536/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Background Malignant wounds can present in up to 14.5% of patients with advanced cancer, significantly reducing quality of life (QoL). Management of malignant wounds is generally palliative, with the goal of improving or maintaining QoL. There is a lack of data on the impact of wound care clinics on QoL in patients with malignant wounds. Objectives We sought to assess the QoL in patients with malignant wounds attending a wound care clinic. We also aimed to describe the baseline QoL, trends in QoL, physical symptoms, and treatment modalities that affect QoL in patients with malignant wounds over time. Methods This retrospective observational study included 36 patients attending a wound care clinic at an oncologic hospital from 1/1/2016-4/1/2023. As part of the standard of care, these patients complete a Skindex-16 QoL survey at each visit. The Skindex-16 is a validated instrument to measure the effects of skin diseases on QoL. Data were extracted from the electronic medical record. Descriptive statistics, graphical methods, and random effects models for change were used to describe the patient population and the QoL measures over time. Results Of the 36 patients who completed at least one Skindex-16 questionnaire, 69.4% were female, and 50.0% developed malignant wounds from breast cancer, 30.5% from nonmelanoma skin cancer, and 8.3% from sarcoma. At the initial visit, 86.1% of patients had exudate associated with their malignant wound, 52.7% of patients had malodor, 63.9% had bleeding, 69.4% had pain, and 50% had pruritus. The mean baseline Skindex-16 score was 54.5, falling into the "extremely severe" category, with a mean score of 15.4, 18.8, and 20.3 for the symptoms, emotions, and functioning domains, respectively. Nineteen patients completed at least one additional Skindex-16 questionnaire at follow-up visits (visit two 52.8%, visit three 33.3%, visit four 19.4%, visit five or greater 13.9%). Compared to the mean Skindex-16 score at baseline, there was an 18.5 point improvement at visit 2 (95% CI: 3.3-33.7, p = 0.018). Conclusion Malignant wounds severely adversely affect patients' quality of life. However, patients experienced improved quality of life after being treated at a dedicated wound clinic.
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Tam SH, Lai WS, Kao CY, Fang SY. "Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan. J Pain Symptom Manage 2024; 68:69-77.e1. [PMID: 38621610 DOI: 10.1016/j.jpainsymman.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
CONTEXT Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. OBJECTIVES To explore the experiences in caring for patients with MFWs among nurses in Taiwan. METHODS Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. RESULTS Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. CONCLUSION The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.
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Affiliation(s)
- Sin Hang Tam
- Medical Oncology and Palliative Care (S.H.T.), St George's University Hospitals NHS Foundation Trust, London, UK
| | - Wei-Sue Lai
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Su-Ying Fang
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan; Department of Nursing (S.Y.F.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Matsubara Y, Kiyonmiya M, Nagayasu T. Examination of the Odor-Eliminating Effect of a Deodorizing Spray on the Volatile Odorants of Malignant Wounds. J Wound Ostomy Continence Nurs 2024; 51:283-287. [PMID: 39037160 DOI: 10.1097/won.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
PURPOSE This study aimed to compare the odor components before and after spraying a deodorizing spray (DS) on volatile odorants in malignant wounds (MWs) in women with breast cancer; a secondary aim was to evaluate the deodorizing effect of the DS. DESIGN This is an observational study. SUBJECTS AND SETTING We investigated 3 patients who had MWs resulting from breast cancer. Participants were recruited from outpatient clinics in the Breast Surgery Department, University Hospital, Kanagawa, Japan. METHODS The target material was exudate-containing dressings collected from MWs. After collection, the odor components (air) were collected into a sampling bag by using a handheld pump. Then, after 5 sprays of a DS, air was collected in the same manner. All odor components were analyzed objectively by gas chromatography-mass spectrometry-olfactometry (GC/MS-O). The concentration in parts per million (ppm) of the main odor components in the air before and after spraying DS was compared, and the residual concentration rate (%) was calculated. Sniffing tests before and after spraying were also conducted to determine the subjective deodorizing effect of DS. RESULTS Of the possible hundreds of volatile odorants, 3 to 11 main components of volatile odorants were detected per subject. After DS spraying, the odorants dimethyl disulfide, dimethyl trisulfide, and benzyl alcohol were reduced according to GC/MS-O. The residual concentration of the following main odor components was also reduced: benzyl alcohol (30%), octanal (56%), p-dichlorobenzene (56%), isovaleric acid (56%), propylene glycol (63%), and nonanal (66%). CONCLUSIONS DS was effective against some volatile odorants in MWs, but no clear deodorizing effect was observed. Since there are individual differences in the type and number of odorants in MWs, the use of DS needs to be examined and verified in a larger number of cases.
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Affiliation(s)
- Yasumi Matsubara
- Yasum Matsubara, PhD, RN, OCNS, CWOCN, Department of Nursing Science, School of Health Sciences, Kitasato University, Niigata, Japan; and Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Mie Kiyonmiya, AA, RN, CWOCN, Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Takahiro Nagayasu, AA, Panasonic Environmental Systems & Engineering Co, Ltd, Osaka, Japan
| | - Mie Kiyonmiya
- Yasum Matsubara, PhD, RN, OCNS, CWOCN, Department of Nursing Science, School of Health Sciences, Kitasato University, Niigata, Japan; and Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Mie Kiyonmiya, AA, RN, CWOCN, Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Takahiro Nagayasu, AA, Panasonic Environmental Systems & Engineering Co, Ltd, Osaka, Japan
| | - Takahiro Nagayasu
- Yasum Matsubara, PhD, RN, OCNS, CWOCN, Department of Nursing Science, School of Health Sciences, Kitasato University, Niigata, Japan; and Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Mie Kiyonmiya, AA, RN, CWOCN, Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
- Takahiro Nagayasu, AA, Panasonic Environmental Systems & Engineering Co, Ltd, Osaka, Japan
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Janowska A, Davini G, Dini V, Iannone M, Morganti R, Romanelli M. Local Management of Malignant and Unresectable Fungating Wounds: PEBO Assessment. INT J LOW EXTR WOUND 2024; 23:320-325. [PMID: 34747269 DOI: 10.1177/15347346211053478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malignant fungating wounds (MFWs) represent a major problem for public health. The most common symptoms associated with MFWs are pain, exudate, bleeding and odor. The aim of the study was to optimize the local management and dressing of MFWs. We developed a standardized 4- step approach to MFWs based on Pain, Exudate, Bleeding and Odor management in a case series of 24 patients: we call this the PEBO approach. We analyzed etiologies, localization, Quality of Life (QoL), pain and clinical signs and symptoms. We assessed the ulcers at baseline, after two weeks and after one month. In our study, most patients showed an improvement in the QoL using PEBO approach, although some experienced a deterioration in their general clinical conditions. Non-cytolesive cleansing, atraumatic dressings were applied to allow pain relief. Non-adherent dressings were combined with a secondary dressing in the case of exudate. Achieving hemostasis with dressing or medication is a priority in MFW management. Antibacterial dressings and odor absorbent dressings were used for odor absorption. Surgical debridement, adherent dressing and occlusive dressings were avoided. Dressing changes were programmed twice a week for four weeks. PEBO simplified the complex aspects of this type of ulcer, and could help physicians, nurses, and also the rest of the team, including the patients themselves and their family, in the multidisciplinary palliative care of MFWs.
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5
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Pramod S, Dumville J, Norman G, Stringer J. A survey of UK nurses about their care of people with malignant fungating wounds. Eur J Oncol Nurs 2024; 70:102609. [PMID: 38810584 DOI: 10.1016/j.ejon.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care. METHOD An online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS. RESULT We received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators. CONCLUSION This is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.
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Affiliation(s)
- Susy Pramod
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - Jo Dumville
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; Division of Nursing, Midwifery & Social Work, School of Health Science, Faculty of Biology, Medicine &Health, University of Manchester, UK
| | - Gill Norman
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; Division of Nursing, Midwifery & Social Work, School of Health Science, Faculty of Biology, Medicine &Health, University of Manchester, UK
| | - Jacqui Stringer
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
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Martínez-García K, Zertuche-Arias T, Bernáldez-Sarabia J, Iñiguez E, Kretzchmar T, Camacho-Villegas TA, Lugo-Fabres PH, Licea Navarro AF, Bravo-Madrigal J, Castro-Ceseña AB. Radical Scavenging, Hemocompatibility, and Antibacterial Activity against MDR Acinetobacter baumannii in Alginate-Based Aerogels Containing Lipoic Acid-Capped Silver Nanoparticles. ACS OMEGA 2024; 9:2350-2361. [PMID: 38250422 PMCID: PMC10795026 DOI: 10.1021/acsomega.3c06114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
Retaining the hemocompatibility, supporting cell growth, and exhibiting anti-inflammatory and antioxidant properties, while having antimicrobial activity, particularly against multidrug-resistant bacteria (MDR), remain a challenge when designing aerogels for biomedical applications. Here, we report that our synthesized alginate-based aerogels containing either 7.5 or 11.25 μg of lipoic acid-capped silver nanoparticles (AgNPs) showed improved hemocompatibility properties while retaining their antimicrobial effect against MDR Acinetobacter baumannii and the reference strain Escherichia coli, relative to a commercial dressing and polymyxin B, used as a reference. The differences in terms of the microstructure and nature of the silver, used as the bioactive agent, between our synthesized aerogels and the commercial dressing used as a reference allowed us to improve several biological properties in our aerogels with respect to the reference commercial material. Our aerogels showed significantly higher antioxidant capacity, in terms of nmol of Trolox equivalent antioxidant capacity per mg of aerogel, than the commercial dressing. All our synthesized aerogels showed anti-inflammatory activity, expressed as nmol of indomethacin equivalent anti-inflammatory activity per mg of aerogel, while this property was not found in the commercial dressing material. Finally, our aerogels were highly hemocompatible (less than 1% hemolysis ratio); however, the commercial material showed a 20% hemolysis rate. Therefore, our alginate-based aerogels with lipoic acid-capped AgNPs hold promise for biomedical applications.
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Affiliation(s)
- Kevin
D. Martínez-García
- Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Tonatzin Zertuche-Arias
- Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Johanna Bernáldez-Sarabia
- Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Enrique Iñiguez
- Ciencias
de la Tierra, Centro de Investigación
Científica y de Educación Superior de Ensenada, Baja
California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
- CONAHCYT—Ciencias
de la Tierra, Centro de Investigación
Científica y de Educación Superior de Ensenada, Baja
California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Thomas Kretzchmar
- Ciencias
de la Tierra, Centro de Investigación
Científica y de Educación Superior de Ensenada, Baja
California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Tanya Amanda Camacho-Villegas
- Unidad
de Biotecnología Médica y Farmacéutica, Centro de Investigación Asistencia en Tecnología
y Diseño de Estado de Jalisco (CIATEJ), A.C. Av. Normalistas No. 800, Colinas de la Normal, C.P. 44270 Guadalajara, Jalisco, Mexico
- CONAHCYT-Unidad
de Biotecnología Médica y Farmacéutica, Centro de Investigación Asistencia en Tecnología
y Diseño del Estado de Jalisco (CIATEJ), A.C. Av. Normalistas No. 800, Colinas de la Normal, C.P. 44270 Guadalajara, Jalisco, Mexico
| | - Pavel H. Lugo-Fabres
- Unidad
de Biotecnología Médica y Farmacéutica, Centro de Investigación Asistencia en Tecnología
y Diseño de Estado de Jalisco (CIATEJ), A.C. Av. Normalistas No. 800, Colinas de la Normal, C.P. 44270 Guadalajara, Jalisco, Mexico
- CONAHCYT-Unidad
de Biotecnología Médica y Farmacéutica, Centro de Investigación Asistencia en Tecnología
y Diseño del Estado de Jalisco (CIATEJ), A.C. Av. Normalistas No. 800, Colinas de la Normal, C.P. 44270 Guadalajara, Jalisco, Mexico
| | - Alexei F. Licea Navarro
- Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
| | - Jorge Bravo-Madrigal
- Unidad
de Biotecnología Médica y Farmacéutica, Centro de Investigación Asistencia en Tecnología
y Diseño de Estado de Jalisco (CIATEJ), A.C. Av. Normalistas No. 800, Colinas de la Normal, C.P. 44270 Guadalajara, Jalisco, Mexico
| | - Ana B. Castro-Ceseña
- Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
- CONAHCYT-Departamento
de Innovación Biomédica, Centro
de Investigación Científica y de Educación Superior
de Ensenada, Baja California (CICESE), Carretera Ensenada-Tijuana No. 3918, Zona Playitas, C.P. 22860 Ensenada, Baja California, Mexico
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McIntyre N, Finlayson K, Galazka A, Lindsay E, Renyi R. The Lindsay Leg Club ® Well Leg Regime: an evidence review. J Wound Care 2023; 32:642-648. [PMID: 37830830 DOI: 10.12968/jowc.2023.32.10.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
This article aims to review the scarce available evidence on the effectiveness of the Well Leg Programme within the Lindsay Leg Clubs in terms of preventing wound recurrence and improving members' wellbeing. It collates the numerical data on members' wounds and healing rates from the Lindsay Leg Club relational database and members' narratives from a qualitative service evaluation of the Lindsay Leg Clubs. Findings of the review suggest that remaining within the Well Leg regime for several months (or longer) after having had a healed ulcer seems to provide further opportunity to prevent recurrence, and may also provide non-clinical benefits, such as improved wellbeing. Based on the review of available published evidence into the effectiveness of the Well Leg regime, we conclude that there is scope for further studies, including a comparison with other existing treatment and prevention protocols.
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Affiliation(s)
| | - Kathleen Finlayson
- Centre for Healthcare Transformation, Queensland University of Technology, Australia
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Abdallah A, Abdelwahab K, Awny S, Zuhdy M, Hamdy O, Atallah K, Elfeky A, Hegazy MAF, Metwally IH. Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends. Indian J Surg Oncol 2023; 14:93-105. [PMID: 36891440 PMCID: PMC9986193 DOI: 10.1007/s13193-022-01602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Fungating breast cancer severely affects patients' daily lives, and patient management poses major oncology challenges. To present 10-year outcomes of unique tumor presentation, suggesting a focused algorithm for surgical management and providing deep analysis for factors affecting survival and surgical outcomes. Eighty-two patients with fungating breast cancer were enrolled in the period from January 2010 to February 2020 in the Mansoura University Oncology Center database. Epidemiological and pathological characteristics, risk factors, different surgical treatment techniques, and surgical and oncological outcomes were reviewed. Preoperative systemic therapy was used in 41 patients, with the majority (77.8%) showing progressive response. Mastectomy was performed in 81 (98.8%) patients, with primary wound closure in 71 (86.6%), and wide local excision in a single patient (1.2%). Different reconstructive techniques in non-primary closure operations were used. Complications were reported in 33 (40.7%) patients, of which 16 (48.5%) were of Clavien-Dindo grade II category. Loco-regional recurrence occurred in 20.7% of patients. The mortality rate during follow-up was 31.7% (n = 26). Estimated mean overall survival (with 95% CI) was 55.96 (41.98-69.9) months; estimated mean loco-regional recurrence-free survival (with 95% CI) was 38.01 (24.6-51.4) months. Surgery is a cornerstone fungating breast cancer treatment option, but at the expense of high morbidity. Sophisticated reconstructive procedures may be indicated for wound closure. A suggested algorithm based on the center's experience of wound management in difficult mastectomy cases is displayed.
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Affiliation(s)
- Ahmed Abdallah
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Khaled Abdelwahab
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Shadi Awny
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Khalid Atallah
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Abeer Elfeky
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Mohammed A. F. Hegazy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Islam H. Metwally
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
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9
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Gethin G, Vellinga A, McIntosh C, Sezgin D, Probst S, Murphy L, Carr P, Ivory J, Cunningham S, Oommen AM, Joshi L, Ffrench C. Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds. J Tissue Viability 2023; 32:151-157. [PMID: 36376189 DOI: 10.1016/j.jtv.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.
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Affiliation(s)
- G Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; CÚRAM, SFI Research Centre for Medical Devices, Ireland.
| | - A Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - C McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland.
| | - D Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - S Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; Care Directorate, University Hospital Geneva, Switzerland.
| | - L Murphy
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - P Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - J Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Irish Research Council (IRC), Government of Ireland, Dublin, Ireland; Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | - S Cunningham
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - A M Oommen
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - Lokesh Joshi
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - C Ffrench
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland; Centre for Pain Research, University of Galway, Ireland.
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10
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Cornish L. Managing malignant wounds in patients receiving palliative care. Nurs Stand 2023; 38:59-66. [PMID: 36530148 DOI: 10.7748/ns.2022.e12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 06/17/2023]
Abstract
Malignant wounds are a complication of cancer and usually develop in patients with advanced disease. Physical symptoms associated with these wounds include pain, bleeding, exudate, malodour and pruritus, while patients may also experience various distressing psychosocial effects. The aim for nurses is to manage these physical symptoms and psychosocial effects, thus enhancing quality of life for patients and their families. This article discusses the symptoms and effects associated with malignant wounds, and explains what is involved in a wound assessment. It also outlines strategies that can be used to manage or eliminate wound-related symptoms and enhance patients' quality of life.
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Furka A, Simkó C, Kostyál L, Szabó I, Valikovics A, Fekete G, Tornyi I, Oross E, Révész J. Treatment Algorithm for Cancerous Wounds: A Systematic Review. Cancers (Basel) 2022; 14:cancers14051203. [PMID: 35267512 PMCID: PMC8909326 DOI: 10.3390/cancers14051203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment strategy, symptoms progress, and adversely influence quality of life. METHODS Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information. RESULTS Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases. CONCLUSIONS This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.
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Affiliation(s)
- Andrea Furka
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Correspondence: ; Tel.: +36-309988499
| | - Csaba Simkó
- Erzsébet Hospice, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary;
| | - László Kostyál
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Department of Diagnostic Imaging, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary
| | - Imre Szabó
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Anikó Valikovics
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Gábor Fekete
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Ilona Tornyi
- Department of Human Genetics, University of Debrecen, 4032 Debrecen, Hungary;
- Biosystems Immunolab Zrt., 4032 Debrecen, Hungary
| | - Endre Oross
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - János Révész
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
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Uebach B, Krull E, Simon ST, Bausewein C, Voltz R, Doll A. [Guideline-based Care for patients with malignant lesions : The new S3 guideline for patients with incurable cancer]. HNO 2022; 70:167-178. [PMID: 35171305 DOI: 10.1007/s00106-022-01145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is a lack of evidence-based guidelines about fungating wounds and a confusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patients with malignant wounds and stabilize or improve their quality of life. The guideline is constructed following the German Instrument for Methodological Guideline Appraisal (DELBI): A systematic review was carried out for guidelines and reviews. A wound expert group discussed these research findings and suggested recommendations which were adapted and consented by representatives of 62 medical and health professionals associations.The guideline has 34 recommendations, thereof nine (26%) are evidence based with an evidence level from 2+ to 4 (according to SIGN). The assessment chapter comprises specific assessment tools for malignant wounds, odor and wound-related quality of life. Three recommendations address the psychosocial support of patients and their family caregivers and aim to reduce the impact of the wound on their emotional wellbeing, caregiver burden and social participation. The pain recommendations focus on a preventive atraumatic dressing change, positioning, systemic pain medication (anticipated, rescue and baseline) and local application of morphine or local anesthetics. The guideline gives recommendations on odor management (metronidazole, active coal and antiseptic dressings) and management of exudate (super absorber). The recommendations on prevention and management of bleeding (antifibrinolytica, haemostyptica) are vital for patients and caregivers. This guideline is one of the first evidence-based and consented guideline on malignant wound care and has the potential to improve the palliation of patients who suffer from there malignant wounds.
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Affiliation(s)
- Barbara Uebach
- Zentrum für Palliativmedizin, Helios Klinikum Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, 53123, Bonn, Deutschland.
| | - Elisabeth Krull
- Zentrum für Ambulante Hospiz- und Palliativversorgung München Land und Stadtrand Caritas-Zentrum Taufkirchen, Deutschland, Oberhaching
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | | | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Axel Doll
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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O'Neill L, Nelson Z, Ahmad N, Fisher AH, Denton A, Renzi M, Fraimow HS, Stanisce L. Malignant Fungating Wounds of the Head and Neck: Management and Antibiotic Stewardship. OTO Open 2022; 6:2473974X211073306. [PMID: 35155974 PMCID: PMC8832587 DOI: 10.1177/2473974x211073306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Malignant fungating wounds (MFWs) are unfortunate and underreported manifestations of some advanced head and neck cancers. The management of MFWs is complex and challenging. MFWs are often mistaken for infectious processes/abscesses and treated indiscriminately with oral or intravenous antibiotics. Our aim is to promote awareness of MFWs and provide education on their management. We summarize their cost-effective and evidence-based therapies and highlight antibiotic stewardship with respect to their management. Data Sources A literature review was performed of PubMed, Cochrane Review, SCOPUS, Embase, and Google Scholar databases regarding topical and systemic treatments for MFWs. Review Methods Full-text articles were identified with the following terms: fungating, ulcerative, wound, tumor, malignancy, antibiotics, topical, dressings, radiotherapy, head, neck, scalp, face, lip, and ear. Treatment recommendations were extrapolated, categorically summarized, and retrospectively assigned with an evidence level based on the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation). Conclusions In the absence of systemic signs and symptoms of infections, MFWs should not be treated as conventional infections or abscesses, with prophylactic oral or intravenous antibiotics. Topical treatments such as ointments and wound dressings are the mainstay in terms of managing the unsightly appearance and fetid odor from these entities. Implications for Practice MFWs are most often not amenable to definitive/curative surgical or nonsurgical therapy, but consultation with a head and neck oncologic specialist will help to determine if the underlying malignancy requires surgery, radiation therapy, or palliative treatment.
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Affiliation(s)
- Liam O'Neill
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Zach Nelson
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Alec H Fisher
- Division of Plastic and Reconstructive Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Ana Denton
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - Michael Renzi
- Department of Dermatology, Cooper University Hospital, Camden, New Jersey, USA
| | - Henry S Fraimow
- Cooper Medical School of Rowan University, Camden, New Jersey, USA.,Division of Infectious Disease, Cooper University Hospital, Camden, New Jersey, USA
| | - Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
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Butler K, Vellinga A, Ivory JD, Cunningham S, Joshi L, Oommen A, Sezgin D, Carr P, Gethin G. Systematic review of topical interventions for the management of odour in patients with chronic wounds or malignant fungating wounds: a study protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13323.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Chronic wounds including venous, arterial, diabetic and pressure ulcers affect up to 2.21 per 1000 population. Malignant fungating wounds affect up to 6.6% of oncology patients. These wounds impact patients and health care systems significantly. Microbes colonising chronic wounds can produce volatile molecules with unpleasant odours. Wound odour adversely affects quality of life, yet management strategies are inconsistent. Clinicians express uncertainty regarding the current range of odour management agents, which therefore requires evaluation for effectiveness. Objective: To determine the effects of topical agents in the management of odour in patients with chronic and malignant fungating wounds. Methods: Searches of Embase, Medline, CINAHL, Cochrane CENTRAL, PubMed, Web of Science, Scopus, and the clinicaltrials.gov and WudracT trial registries from inception to present will be conducted without language limits. Randomised controlled trials including adults with venous, arterial, mixed arterio-venous, diabetic, decubitus or malignant fungating wounds, investigating topical agents to manage odour are eligible. Reference lists of included studies and identified systematic reviews will be scanned, and unpublished studies will be sought in the BASE database, in conference proceedings and through contacting authors. Two reviewers will independently scan titles/abstracts and full text articles against predetermined eligibility criteria, with discrepancies resolved by discussion between reviewers or through third-party intervention. Two reviewers will independently extract data from included studies. Disagreements will be resolved by discussion between reviewers or through third-party intervention. Bias risk and evidence quality will be assessed with the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Meta-analysis will be applied where appropriate. Otherwise, data will be synthesised narratively. Discussion: Wound odour management typically takes a trial-and-error approach. Clinicians are critical of odour management agent effectiveness. This review will evaluate the range of available agents to inform practice and research. PROSPERO registration: CRD42021267668 (14/08/2021)
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Agra G, Formiga NS, Oliveira SHS, Sousa ATO, Soares MJGO, Lopes Costa MM. Instrument Validation on Nurses’ Knowledge and Practice in Palliative Care for People with Cutaneous Malignant Tumor Wound. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: to present the construction and validation process of an instrument to evaluate the knowledge and practice of nurses in palliative care toward the person with cutaneous malignant tumor wound.
Materials and Methods: methodological, quantitative study with applying the Delphi technique, conducted in two stages. The first was carried out with 30 judges and the second with 17. The analysis used the Lambda 2 Guttmann coefficient, Kappa index, and Content Validity Index (CVI).
Results: of the 112 items of the original instrument, 28 were excluded, given that the percentiles of Lambda 2 Guttmann, Kappa, and CVI had indicators lower than acceptable; thus, the second version of the instrument resulted with 84 items, which presented 100 % acceptance in the Delphi 2 phase.
Conclusions: from the evaluation by the judges, a version of the instrument was defined with adequate content validity and concordance indices, which could contribute to the evaluation of knowledge and practice of nurses in palliative care toward the person with cutaneous malignant tumor wound.
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Schmidt FMQ, Firmino F, Lenza NDFB, Santos VLCDG. Nursing team knowledge on care for patients with fungating wounds. Rev Bras Enferm 2020; 73:e20170738. [DOI: 10.1590/0034-7167-2017-0738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher’s exact test, Student’s t-Test and Pearson’s correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.
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Ousey K, Roberts D, Gefen A. Early identification of wound infection: understanding wound odour. J Wound Care 2019; 26:577-582. [PMID: 28976829 DOI: 10.12968/jowc.2017.26.10.577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Malodorous wounds can be distressing for patients and their families, negatively impacting on quality-of-life outcomes. For health professionals malodorous wounds can also cause distress manifesting in feelings of disgust when faced with a wound emitting an unpleasant or repulsive odour. There has been investigation into the management of controlling odour particularly in relation to fungating wounds. However, there is limited research that explores techniques for early identification and recognition of wound odours that may be indicative of infection. Electronic nose technology has received some attention, but to date has not been integrated into either diagnostics of infection in wounds or education of health professionals to prepare them for the realities of clinical practice.
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Affiliation(s)
- K Ousey
- Professor, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - D Roberts
- Foundation of Nursing Studies Professor, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A Gefen
- Professor, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Agra G, Soares Formiga N, dos Santos Oliveira SH, Oliveira de Sousa AT, Guimarães Oliveira Soares MJ, Lopes Costa MM. Indicadores psicométricos do saber e o fazer de enfermeiros nos cuidados paliativos à pessoa com ferida tumoral. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: verificar la discriminación de ítems, la relevancia del contenido y la fidelidad de la medida, acerca del saber y del hacer de enfermeros, en los cuidados paliativos a las personas con herida tumoral maligna cutánea. Material y método: estudio metodológico, descriptivo y correlacional, realizado con 51 enfermeros de un hospital filantrópico de Paraíba, Brasil, durante junio y julio de 2017, quienes contestaron a un instrumento con 84 ítems referentes al saber y el hacer en los cuidados paliativos, destinados a la persona con herida tumoral maligna cutánea. En el análisis de los datos se utilizó el programa SPSS para Windows, versión 22.0, con análisis descriptivos y psicométricos. Resultados: al verificar las propiedades psicométricas, la autenticidad de los ítems presentó alfa de Cronbach superior a 0,70 en todos los dominios. Por lo tanto, fue posible elaborar un presupuesto teórico sobre el fenómeno, en lo que, cuanto mayor sea el saber relacionado a los cuidados paliativos a la persona con herida tumoral maligna cutánea, mayor será la acción de estos cuidados. Conclusiones: este instrumento posibilita que otros profesionales puedan adecuar la misma metodología a otras temáticas e identificar las especificidades del saber y del hacer, lo que podría llenar los vacíos en el área de educación en enfermería, sobre todo en la temática de cuidados paliativos.
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Polyhexanide Versus Metronidazole for Odor Management in Malignant (Fungating) Wounds. J Wound Ostomy Continence Nurs 2018; 45:413-418. [DOI: 10.1097/won.0000000000000460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Suzanne Tandler
- Tissue Viability Nurse. Worcestershire Health & Care NHS Trust
| | - Jackie Stephen-Haynes
- Professor in Tissue Viability, Professional Development Unit, Birmingham City University and Consultant Nurse, Worcestershire Health and Care NHS
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Tamai N, Mugita Y, Ikeda M, Sanada H. The relationship between malignant wound status and pain in breast cancer patients. Eur J Oncol Nurs 2016; 24:8-12. [PMID: 27697281 DOI: 10.1016/j.ejon.2016.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Skin metastasis is one of the most frequent metastases in breast cancer patients. Patients with malignant wounds experience numerous symptoms, including serious wound pain. However, the features of pain related to malignant wounds have not been investigated. Nurses can experience a dilemma when treating these patients due to a lack of knowledge of the pain. The aims of this study were to examine the quality and intensity of malignant wound pain and to determine the association between wound status and pain in the patients with malignant wounds. METHODS Cross-sectional study was conducted. Participants were recruited from a breast centre based in a general hospital. We collected the patients' demographic and wound management data and assessed wound condition. Patients evaluated wound pain intensity and quality over the preceding week using the short-form McGill Pain Questionnaire (SF-MPQ). The association between SF-MPQ results, wound condition, and the time interval for wound care was evaluated using the Spearman's correlation coefficient. The protocol was approved by the Ethical Committee of the each facilities. RESULTS The median age of the 22 enrolled patients was 61.5 years, and the median time after diagnosis of malignant wound was 15.5 months. Overall, 77.3% of patients complained of pain. Malignant wound pain significantly correlated with the degradation of wound edges, granulation tissue, and the time interval for wound care. CONCLUSION We consider that it is necessary to provide pain-control care focused on the wound edge and granulation tissue of malignant wounds through the assessment of malignant wound pain and condition.
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Affiliation(s)
- Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mari Ikeda
- Department of Nursing Administration and Advanced Clinical Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Scientific and Clinical Abstracts From the 2016 WOCN® Society & CAET Joint Conference. J Wound Ostomy Continence Nurs 2016. [DOI: 10.1097/won.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tamai N, Akase T, Minematsu T, Higashi K, Toida T, Igarashi K, Sanada H. Association Between Components of Exudates and Periwound Moisture-Associated Dermatitis in Breast Cancer Patients With Malignant Fungating Wounds. Biol Res Nurs 2015; 18:199-206. [PMID: 26180182 DOI: 10.1177/1099800415594452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Excessive wound exudates are troublesome symptoms of malignant fungating wounds. In particular, such exudates may cause periwound moisture-associated dermatitis (MAD). In this study, we focused on factors that contribute to skin irritation by exudates in breast cancer patients with malignant fungating wounds. Our aim was to identify the relationship between MAD surrounding malignant fungating wounds and levels of various candidate irritating factors in their exudates. We recruited 20 breast cancer patients with exudates from malignant fungating wounds and collected three types of exudate samples: pooled exudate, swab, and fresh exudate samples. We measured the pH, concentrations of polyamines (putrescine [PUT], cadaverine [CAD], spermidine, and spermine), and matrix metalloproteinases (MMP2 and MMP9) in the exudates and cultured them for bacteria. Differences between participants with and without MAD were assessed using Fisher's exact test or the Mann-Whitney U test. Of the 20 participants, 14 had MAD. There were no significant differences in median pH and MMP activity between patients with and without MAD. The level of PUT was significantly higher in the MAD than in the non-MAD group (p = .008), and CAD was detected only in the MAD group (p = .016). Prospective studies are needed to clarify correlations and causal relationships between polyamines and erythema and identify therapeutic targets for preventing the development of MAD.
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Affiliation(s)
- Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoko Akase
- Department of Biological Science and Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kyohei Higashi
- Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Toshihiko Toida
- Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Kazuei Igarashi
- Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Palliative Wound Care Management Strategies for Palliative Patients and Their Circles of Care. Adv Skin Wound Care 2015; 28:130-40; quiz 140-2. [DOI: 10.1097/01.asw.0000461116.13218.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gethin G, Grocott P, Probst S, Clarke E. Current practice in the management of wound odour: An international survey. Int J Nurs Stud 2014; 51:865-74. [DOI: 10.1016/j.ijnurstu.2013.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/26/2022]
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Meaume S, Fromantin I, Teot L. Neoplastic wounds and degenerescence. J Tissue Viability 2013; 22:122-30. [DOI: 10.1016/j.jtv.2013.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/16/2013] [Accepted: 07/24/2013] [Indexed: 12/13/2022]
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Morphological characteristics of and factors related to moisture-associated dermatitis surrounding malignant wounds in breast cancer patients. Eur J Oncol Nurs 2013; 17:673-80. [DOI: 10.1016/j.ejon.2013.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 05/11/2013] [Accepted: 05/14/2013] [Indexed: 11/18/2022]
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Fromantin I, Seyer D, Watson S, Rollot F, Elard J, Escande MC, De Rycke Y, Kriegel I, Larreta Garde V. Bacterial floras and biofilms of malignant wounds associated with breast cancers. J Clin Microbiol 2013; 51:3368-73. [PMID: 23926169 PMCID: PMC3811619 DOI: 10.1128/jcm.01277-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/29/2013] [Indexed: 12/17/2022] Open
Abstract
The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10(5) · g(-1). The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.
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Affiliation(s)
- Isabelle Fromantin
- Departments of Supportive Care
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
| | - Damien Seyer
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
| | | | | | | | | | | | - Irène Kriegel
- Anesthesia Reanimation, Institut Curie, Paris, France
| | - Véronique Larreta Garde
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
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Willis S, Sutton J. Managing complex palliative wounds: an interactive educational approach for district nurses. Int J Palliat Nurs 2013; 19:457-62. [DOI: 10.12968/ijpn.2013.19.9.457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shirley Willis
- Cardiff and Vale University Health Board, Vale Locality, Vale of Glamorgan, Wales
| | - Joanne Sutton
- Primary Care and Public Health, School of Health Care Sciences, College of Biomedical and Life Sciences, Cardiff University, Eastgate House, 35–43 Newport Road, Cardiff CF24 0AB, Wales
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Gibson S, Green J. Review of patients' experiences with fungating wounds and associated quality of life. J Wound Care 2013; 22:265-6, 268, 270-2, passim. [PMID: 23702724 DOI: 10.12968/jowc.2013.22.5.265] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the evidence exploring the experiences of patients with fungating wounds and associated quality of life, and to subsequently provide recommendations to how these implications may be addressed in practice. METHOD Using a systematic approach, a comprehensive literature search was conducted to investigate the most appropriate and relevant evidence regarding the experiences of patients with fungating wounds. RESULTS Studies unveiled the enormity of the unrelenting, unique and devastating consequences that these wounds have on an individual’s life and that every domain of their life is negatively affected. CONCLUSION These findings must galvanise nurses to become aware of the extent of the devastation experienced and aspects of life affected by these wounds. The issues raised have multifaceted and challenging implications for practice; however, all aspects need to be addressed and satisfied in an attempt to improve the quality of life of individuals with fungating wounds.
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Affiliation(s)
- S Gibson
- Critical Care Unit, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
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Probst S, Arber A, Faithfull S. Coping with an exulcerated breast carcinoma: an interpretative phenomenological study. J Wound Care 2013; 22:352-4, 356-8, 360. [DOI: 10.12968/jowc.2013.22.7.352] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Probst
- Department of Health, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - A. Arber
- Department of Health and Social Sciences, University of Surrey, Guildford, UK
| | - S. Faithfull
- Department of Health and Social Sciences, University of Surrey, Guildford, UK
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Gottrup F, Apelqvist J, Bjarnsholt T, Cooper R, Moore Z, Peters E, Probst S. EWMA Document: Antimicrobials and Non-healing Wounds: Evidence, controversies and suggestions. J Wound Care 2013; 22:S1-89. [DOI: 10.12968/jowc.2013.22.sup5.s1] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- F Gottrup
- Professor of Surgery, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Apelqvist
- Senior Consultant, Associate Professor, Skåne University Hospital, Malmö, Sweden
| | - T Bjarnsholt
- Associate Professor, University of Copenhagen and Copenhagen University Hospital, Copenhagen, Denmark
| | - R Cooper
- Professor of Microbiology, Cardiff Metropolitan University, Cardiff, Wales, United Kingdom
| | - Z Moore
- Lecturer in Wound Healing & Tissue Repair, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E.J.G. Peters
- Internist- Infectious Diseases Specialist, VU University Medical Center, Amsterdam, the Netherlands
| | - S Probst
- Lecturer, Zurich University of Applied Sciences, Winterthur, Switzerland
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Probst S, Arber A, Faithfull S. Malignant fungating wounds – The meaning of living in an unbounded body. Eur J Oncol Nurs 2013; 17:38-45. [DOI: 10.1016/j.ejon.2012.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/06/2012] [Accepted: 02/09/2012] [Indexed: 11/16/2022]
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Caring for a loved one with a malignant fungating wound. Support Care Cancer 2012; 20:3065-70. [DOI: 10.1007/s00520-012-1430-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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Lo SF, Hayter M, Hu WY, Tai CY, Hsu MY, Li YF. Symptom burden and quality of life in patients with malignant fungating wounds. J Adv Nurs 2011; 68:1312-21. [PMID: 22043819 DOI: 10.1111/j.1365-2648.2011.05839.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds. BACKGROUND Malignant fungating wounds are complex wounds that can bleed, become malodorous due to infection and are painful causing physical and psychological distress. However, there is a lack of literature on the impact that such wounds can have on quality of life. METHODS This was a descriptive, cross-sectional multi-centre study of patients with malignant fungating wounds. Participants were recruited from the palliative care, hospice, outpatient clinic and oncology units of three medical centres in Taiwan. Data were collected from February 2008 to August 2009. A structured questionnaire obtained socio-demographic information, medical details, wound assessment information and the Taiwanese version of the McGill quality of life questionnaire was administered by interview. RESULTS McGill quality of life scores indicated that the participants had the lowest quality of life. The participant's age, dressing change frequency, pain, wound dressing comfort, wound symptom, bleeding and malodour had statistically significant negative correlations with quality of life. Multiple regression analysis showed that age, malodour, pain issues and psychological issues explained 87% of the total variance in quality of life. CONCLUSION This study contributes to our understanding of the impact of malignant fungating wounds and how correct assessment and management is necessary to improve quality of life. Educational intervention research is needed for patients and caregivers in countries where this has not yet been performed. Further research should also identify whether nursing competence has a direct impact on quality of life.
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Affiliation(s)
- Shu-Fen Lo
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
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