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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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Liu X, Xie JQ, Liao ZY, Wei MJ, Lin H. Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds. J Wound Care 2024; 33:262-270. [PMID: 38573899 DOI: 10.12968/jowc.2024.33.4.262] [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: 04/06/2024]
Abstract
OBJECTIVE This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL. METHOD This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models. RESULTS A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds. CONCLUSION The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.
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Affiliation(s)
- Xin Liu
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Jin-Qin Xie
- Nursing department, Guangxi Medical University Affiliated Cancer Hospital, NanNing 530021, China
| | - Zhao-Yu Liao
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Mei-Juan Wei
- Department of Oncology, Affiliated Hospital of Youjiang Medical College for Nationalities, BaiSe 533099, China
| | - Hua Lin
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
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Yasmara D, Tam SH, Fang SY. Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review. J Wound Ostomy Continence Nurs 2024; 51:19-25. [PMID: 38215293 DOI: 10.1097/won.0000000000001046] [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: 01/14/2024]
Abstract
PURPOSE The aim of this scoping literature review was to identify current knowledge related to management of malignant fungating wounds (MFWs), gaps in this knowledge, and areas for future research. METHODS This was a scoping literature review. SEARCH STRATEGY Six electronic databases (Embase, MEDLINE, Cochrane (CENTRAL), CINAHL, Scopus, and Web of Science) were searched spanning the years 1987 and 2022. The initial electronic database search retrieved 6041 studies. The search is based on 60 articles published between 1987 and 2022, along with 14 additional studies were based on search of reference lists of key articles. FINDINGS Studies were divided into 2 main domains; the vast majority (65 of 72, 87.8%) focused on symptom impact, measurement, and management. The remaining articles (n = 9, 12.2%) focused on caring for patients with MFW; these studies focused on nursing care experiences and competencies, along with lay caregiver experiences. Findings indicated that instruments have been developed to evaluate symptoms of MFW but only a few have been validated. Most of the studies reviewed evaluated the influence of MFW on physical and psychosocial function. Local and systematic symptom managements such as modern dressings, wound care strategies, surgery, and radiotherapy as well as chemotherapy were found to be effective in alleviating symptoms. Findings also indicated that families and nurses encounter obstacles and burdens when caring for patients with MFW; limited studies were retrieved that investigated the competence and needs of nurses in their caring journey. IMPLICATIONS Future studies should focus on: (1) using better designs to evaluate and compare topical agents and dressings to control odor, (2) validating assessment tools specific to MFW, (3) qualitative studies designed to enhance understanding family and nurses' experiences, and (4) improving the nurse's ability to care for patients with MFWs and their responses to managing these challenging patients.
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Affiliation(s)
- Deni Yasmara
- Deni Yasmara, MN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Sin-Hang Tam, MSN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Su-Ying Fang, PhD, RN, Department of Nursing, College of Medicine, National Cheng Kung University and Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sin-Hang Tam
- Deni Yasmara, MN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Sin-Hang Tam, MSN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Su-Ying Fang, PhD, RN, Department of Nursing, College of Medicine, National Cheng Kung University and Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-Ying Fang
- Deni Yasmara, MN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Sin-Hang Tam, MSN, RN, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Su-Ying Fang, PhD, RN, Department of Nursing, College of Medicine, National Cheng Kung University and Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Niculescu AG, Georgescu M, Marinas IC, Ustundag CB, Bertesteanu G, Pinteală M, Maier SS, Al-Matarneh CM, Angheloiu M, Chifiriuc MC. Therapeutic Management of Malignant Wounds: An Update. Curr Treat Options Oncol 2024; 25:97-126. [PMID: 38224423 DOI: 10.1007/s11864-023-01172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
OPINION STATEMENT Malignant fungating wounds (MFW) are severe skin conditions generating tremendous distress in oncological patients with advanced cancer stages because of pain, malodor, exudation, pruritus, inflammation, edema, and bleeding. The classical therapeutic approaches such as surgery, opioids, antimicrobials, and application of different wound dressings are failing in handling pain, odor, and infection control, thus urgently requiring the development of alternative strategies. The aim of this review was to provide an update on the current therapeutic strategies and the perspectives on developing novel alternatives for better malignant wound management. The last decade screened literature evidenced an increasing interest in developing natural treatment alternatives based on beehive, plant extracts, pure vegetal compounds, and bacteriocins. Promising therapeutics can also be envisaged by involving nanotechnology due to either intrinsic biological activities or drug delivery properties of nanomaterials. Despite recent progress in the field of malignant wound care, the literature is still mainly based on in vitro and in vivo studies on small animal models, while the case reports and clinical trials (less than 10 and only one providing public results) remain scarce. Some innovative treatment approaches are used in clinical practice without prior extensive testing in fungating wound patients. Extensive research is urgently needed to fill this knowledge gap and translate the identified promising therapeutic approaches to more advanced testing stages toward creating multidimensional wound care strategies.
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Affiliation(s)
- Adelina-Gabriela Niculescu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, National University of Science and Technology Politehnica Bucharest, 011061, Bucharest, Romania
| | - Mihaela Georgescu
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Department of Dermatology, Dr. Carol Davila Central Military, Emergency University Hospital, Bucharest, Romania
| | - Ioana Cristina Marinas
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania.
| | - Cem Bulent Ustundag
- Department of Bioengineering, Faculty of Chemical and Metallurgical Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Gloria Bertesteanu
- ENT Department, University of Medicine and Pharmacy Carol Davila and Coltea Clinical Hospital, 020022, Bucharest, Romania
| | - Mariana Pinteală
- Centre of Advanced Research in Bionanoconjugates and Biopolymers, "Petru Poni" Institute of Macromolecular Chemistry, Iasi, Romania
| | - Stelian Sergiu Maier
- Centre of Advanced Research in Bionanoconjugates and Biopolymers, "Petru Poni" Institute of Macromolecular Chemistry, Iasi, Romania
- Department of Chemical Engineering, Faculty of Industrial Design and Business Management, Gheorghe Asachi" Technical University of Iasi, Iasi, Romania
| | - Cristina Maria Al-Matarneh
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Centre of Advanced Research in Bionanoconjugates and Biopolymers, "Petru Poni" Institute of Macromolecular Chemistry, Iasi, Romania
| | - Marian Angheloiu
- Research and Development Department of SC Sanimed International Impex SRL, 6 Bucharest-Giurgiu Street, Giurgiu, Romania
| | - Mariana Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, 1-3 Portocalelor Street, Bucharest, Romania
- The Romanian Academy, 25, Calea Victoriei, District 1, Bucharest, Romania
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Sezgin D, Geraghty J, Graham T, Blomberg K, Charnley K, Dobbs S, McElvaney A, Probst S, Beeckman D, Grocott P, Gethin G. Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce. J Tissue Viability 2023; 32:627-634. [PMID: 37482507 DOI: 10.1016/j.jtv.2023.07.002] [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] [Received: 03/07/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION A review protocol was developed but not registered.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - Jemell Geraghty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Tanya Graham
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care (AIIHPC), Dublin, Ireland
| | - Sharon Dobbs
- Wellington Hospital HCA Healthcare, London, United Kingdom
| | - Aideen McElvaney
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Sebastian Probst
- 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, Geneva, Switzerland; University Hospital Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Sweden
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
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Gethin G, LeBlanc K, Ivory JD, McIntosh C, Pastor D, Naughten E, Hobbs C, McGrath B, Cunningham S, Joshi L, Moloney S, Probst S. A protocol for a scoping review to identify methods used in clinical practice to assess wound odour. HRB Open Res 2023; 6:54. [PMID: 39290784 PMCID: PMC11406125 DOI: 10.12688/hrbopenres.13739.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 09/19/2024] Open
Abstract
Objective: The objective of this scoping review is to map, from wound assessment tools and other literature, the current methods used to assess wound odour in order to answer the following question: Which methods of assessment, validated or otherwise, are currently used in wound assessment tools to assess wound odour? Introduction: Wound assessment includes not only details of the condition of the wound bed but also evaluation of symptoms associated with the wound including that of odour. Odour is cited by clinicians, patients and carers as one of the most distressing wound symptoms. However, there is no consensus on a preferred method to assess odour thus negatively impacting the internal and external validity of many clinical trials and minimising the ability to perform meta-analysis. Eligibility criteria: Any wound assessment tool or framework that includes assessment of wound odour in any wound aetiology and in any care setting. Any systematic or scoping review that includes assessment of wound odour in any wound aetiology and in any care setting. No limits on date of publication or language will be applied. Methods: We will employ the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines for this scoping review and base its structure on the framework proposed by Arksey and O'Malley. Results: A narrative format will summarise extracted data and provide an overview of tools used to assess wound odour. A PRISMA diagram will outline the results of the search strategy. The identified tools will be summarised in table format and stratified according to methods used. Conclusion: The result of this scoping review will be a list of methods used to assess odour in wounds and will be used to inform a subsequent Delphi study to gain consensus on the preferred method to assess wound odour.
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Affiliation(s)
- Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- University of Galway, Alliance for Research and Innovation in Wounds, Galway, Ireland
- Geneva School of Health Sciences, HES-SO University of Allied Sciences and Arts, Geneva, Switzerland
| | | | - John D Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- University of Galway, Alliance for Research and Innovation in Wounds, Galway, Ireland
| | - Caroline McIntosh
- University of Galway, Alliance for Research and Innovation in Wounds, Galway, Ireland
- School of Health Sciences, University of Galway, Galway, Ireland
| | - Damien Pastor
- Department of Dermatology and Venerology, University Hospital Geneva, Geneva, Switzerland
| | - Enda Naughten
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- University of Galway, Alliance for Research and Innovation in Wounds, Galway, Ireland
| | - Chloe Hobbs
- School of Biological and Chemical Sciences, University of Galway, Galway, Ireland
| | - Barry McGrath
- HS Ireland, Hidradenitis Suppurativa Association, County Clare, Ireland
| | - Stephen Cunningham
- School of Biological and Chemical Sciences, University of Galway, Galway, Ireland
| | - Lokesh Joshi
- School of Biological and Chemical Sciences, University of Galway, Galway, Ireland
| | - Suzanne Moloney
- University of Galway, Alliance for Research and Innovation in Wounds, Galway, Ireland
- HS Ireland, Hidradenitis Suppurativa Association, County Clare, Ireland
| | - Sebastian Probst
- Geneva School of Health Sciences, HES-SO University of Allied Sciences and Arts, Geneva, Switzerland
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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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Pađen L, Griffiths J, Cullum N. “Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound. Int J Qual Stud Health Well-being 2022; 17:2123932. [PMID: 36102138 PMCID: PMC9481149 DOI: 10.1080/17482631.2022.2123932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. Methods A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. Results We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”. Conclusion Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.
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Affiliation(s)
- Ljubiša Pađen
- Department of Nursing, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, the University of Manchester, Manchester, UK
- Research & Innovation Division, Manchester University NHS Foundation Trust Research Office, Manchester, UK
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Fungating Malignancies: Management of a Distinct Wound Entity. Adv Skin Wound Care 2022; 35:646-652. [PMID: 36409187 DOI: 10.1097/01.asw.0000891852.64709.fe] [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]
Abstract
GENERAL PURPOSE To provide information on the surgical management of fungating malignancies as a distinct wound entity. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify characteristics of patients in a study examining the treatment of fungating malignancies.2. Select common symptoms experienced by patients with fungating malignancies.3. Explain issues related to the surgical treatment of fungating malignancies.4. Identify a reason why patients with fungating breast masses may avoid medical care.
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10
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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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Probst S, Saini C, Rosset C, Skinner MB. Superabsorbent charcoal dressing versus silver foam dressing in wound area reduction: a randomised controlled trial. J Wound Care 2022; 31:140-146. [PMID: 35148626 DOI: 10.12968/jowc.2022.31.2.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM This study aimed to compare the effect of a novel sterile polyacrylate wound pad with activated carbon cloth treatment with a standard non-adhesive hydrocellular foam dressing with silver in reducing wound area. METHOD A multicentre randomised controlled open-label wound-dressing trial was conducted in two wound care outpatient clinics in western Switzerland from November 2018 to March 2020. RESULTS A total of 77 successive patients were randomised to receive either a sterile polyacrylate wound pad with activated carbon cloth treatment (n=38) or the standard non-adhesive hydrocellular foam dressing with silver (n=39). Reduction in wound area was the primary outcome, whereas the application period of the dressing, odour, maceration and pain were the secondary outcomes. Wound area was measured at baseline and during each wound dressing change until the dressings were no longer indicated. Wound area reduced faster in the intervention group than in the control group (0.45cm2 per day vs. 0.2cm2 per day), although the application period was longer in the intervention group compared with the control group (9.5 days vs. 8.1 days). Maceration reduction was more pronounced in the intervention group (-2.07cm2) than in the control group (-0.71cm2). Odour, pain and infection were similar in both groups. CONCLUSION Sterile polyacrylate wound pad dressings with activated carbon cloth reduced the wound area, as well as the maceration area, faster than the non-adhesive hydrocellular foam dressing with silver.
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Affiliation(s)
- Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland.,Care Directorate, University Hospital, Geneva, Switzerland.,Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Camille Saini
- HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | | | - Monika Buehrer Skinner
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Luo B, Xiao Y, Jiang M, Wang L, Ge Y, Zheng M. Successful Management of Exudate and Odor Using a Pouch System in a Patient with Malignant Facial Wound: A Case Report. Asia Pac J Oncol Nurs 2022; 9:236-241. [PMID: 35571624 PMCID: PMC9096734 DOI: 10.1016/j.apjon.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant fungating wounds are associated with heavy exudate and malodor, and can thus have a devastating impact on the physical, psychological, and functional health of patients at the end of life. Management is typically limited to the use of more absorbent dressings and frequent changing of dressings. However, this method is associated with a large amount of time needed for wound care, and does not always resolve the problem of malodor. Herein, we report the use of an inexpensive ostomy pouch to manage facial fungating wounds caused by maxillary gingival carcinoma. The pouches are adhered to the skin, and collect a large amount of malodorous exudate for days without leaking. Fewer dressing changes and the absence of malodor result in an improved quality of life for the patient and family.
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Rupert KL, Fehl AJ. A Patient-Centered Approach for the Treatment of Fungating Breast Wounds. J Adv Pract Oncol 2020; 11:503-510. [PMID: 32974074 PMCID: PMC7508249 DOI: 10.6004/jadpro.2020.11.5.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nearly 2% to 5% of locally advanced breast cancers develop a fungating breast wound (FBW). Fungating breast wounds develop when malignant cells infiltrate the skin and cause breakdown, ulceration, and infection. Although systemic and locoregional control of locally advanced breast cancer is necessary, appropriate management of the wound is also crucial. With limited research and reference literature involving FBW, management of FBW is not well understood. The following article will highlight the comprehensive care approach needed to manage the patient with FBW, including medical management of the locally advanced breast cancer, addressing psychosocial complications, pain management, and wound care with appropriate dressing recommendations according to the specific wound characteristics. In addition, examples and brand names will be given, as the availability of products may be dictated by the facility, or price comparisons may need to be made for the patient who will have out-of-pocket costs.
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Affiliation(s)
- Karlyn L Rupert
- Magee-Womens Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrea J Fehl
- Magee-Womens Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Malignant Wounds in Hospitalized Oncology Patients: Prevalence, Characteristics, and Associated Factors. Plast Surg Nurs 2020; 40:138-144. [PMID: 32852440 DOI: 10.1097/psn.0000000000000320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiological and descriptive research on malignant wounds (MWs) is scarce. The objective of this study was to identify the prevalence of MWs and analyze the characteristics and associated factors of MWs in hospitalized patients at an oncological institution. An epidemiological, cross-sectional, and descriptive study, which was derived from a larger study that collected data on the prevalence of different types of wounds in 341 adults hospitalized in a large oncological hospital, was conducted. The present study comprehensively analyzed data related to MWs. Information was obtained through participant interviews, physical examination, and medical record review. The study was approved by the ethics committee of the institution where the study was conducted. Fourteen MWs were identified in 13 patients, who were primarily married (58%) and men (75%), with a mean age of 60.5 ± 15.1 years. Malignant wounds were predominantly located in the head and neck region (43%) and classified as 1N (50%) according to the Staging of Malignant Cutaneous Wounds instrument. Malignant wounds were characterized as painful (83.3%), with significant pain present during dressing changes (93%). The presence of MWs was associated with the use of antidepressants (odds ratio [OR] = 4.95; p = .012), upper-limb edema (OR = 8.39; p = .003), and infection (OR = 12.16; p = .051). The prevalence of MWs in hospitalized patients was 3.8%. Associated clinical variables were related to the degree of disease progression. This information provides evidence of the need for research identifying and investigating nursing interventions for patients with MW to assist with pain control during dressing changes.
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Tilley CP, Fu MR, Van Cleeve J, Crocilla BL, Comfort CP. Symptoms of Malignant Fungating Wounds and Functional Performance among Patients with Advanced Cancer: An Integrative Review from 2000 to 2019. J Palliat Med 2020; 23:848-862. [DOI: 10.1089/jpm.2019.0617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles P. Tilley
- New York University Rory Meyers College of Nursing, New York, New York, USA
- Calvary Hospital and Hospice, Bronx, New York, USA
| | - Mei R. Fu
- New York University Rory Meyers College of Nursing, New York, New York, USA
- Boston College William F. Connell School of Nursing, Boston, Massachusetts, USA
| | - Janet Van Cleeve
- New York University Rory Meyers College of Nursing, New York, New York, USA
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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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Peng L, Dai Y. Effect of metronidazole combined with autolytic debridement for the management of malignant wound malodor. J Int Med Res 2019; 48:300060519889746. [PMID: 31885300 PMCID: PMC7607146 DOI: 10.1177/0300060519889746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the effect of metronidazole combined with autolytic debridement for the management of malignant wound malodor. Methods Patients with malignant wounds who underwent dressing change at a wound outpatient clinic from September 2016 to February 2019 were randomized to an observation group (36 patients) or a control group (37 patients). The observation group was treated with metronidazole combined with debridement gel while the control group received wet dressing therapy combined with silver sulfadiazine. Malodor control was compared between the two groups from treatment initiation to days 3 and 12 after dressing change, and the social impact scale was used to compare stigma caused by malodor between the groups before and after treatment. Results The observation group had significantly superior malodor control on days 3 and 12 after dressing change compared with the control group. There was no difference in stigma between the two groups before treatment, but stigma in the observation group was significantly lower than that in the control group after treatment. Conclusion Metronidazole combined with autolytic debridement can effectively reduce the malodor of cancerous wounds while controlling infection, and alleviate patient stigma caused by malodor.
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Affiliation(s)
- Li Peng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dai
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.
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Affiliation(s)
- Lynn Cornish
- Tissue Viability Specialist Lead St. Margaret's Hospice, Somerset
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Abstract
Palliative wound care is a philosophy of wound management that prioritizes comfort over healing and attends to the emotional distress these wounds can cause. Intervention strategies focus on management of symptoms such as pain, odor, bleeding, and exudate. Historic treatments such as honey, chlorine, and vinegar have gained renewed interest, and although well suited to the palliative setting, there is an increasing amount of research exploring their efficacy in other contexts. The lived experience of patients and caregivers facing these wounds is often stressful and isolating, and any treatment plan must address these issues along with the physical aspects of care.
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Pađen L, Griffiths J, Cullum N. A cross-sectional survey of patients with open surgical wounds in Slovenia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e213-e222. [PMID: 30549131 DOI: 10.1111/hsc.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up ("healing by secondary intention") or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross-sectional survey was carried out over a 2-week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33-0.44). Patients' mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development.
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Affiliation(s)
- Ljubiša Pađen
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Department of Nursing, University of Ljubljana, Ljubljana, Slovenia
| | - Jane Griffiths
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Research & Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
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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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Souza MADO, Souza NRD, Melo JTDS, Xavier MACA, Almeida GLD, Santos ICRV. Odor evaluation scales for odor in neoplastic wounds: an integrative review. Rev Bras Enferm 2018; 71:2552-2560. [PMID: 30304189 DOI: 10.1590/0034-7167-2017-0428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Checking for the existence of assessment instruments for odor in neoplastic wounds. METHOD Integrative review performed in the databases Lilacs, SCiELO, Ibecs and MedLine, including national and international publications. RESULTS 15 articles were analyzed, in its majority performed by nurses and being of the revision type. Nine scales were found, of which the majority assesses only the odor intensity. The scale most used to evaluate products and/or bandage covers for neoplastic injuries was the Odor Evaluation Guideline, of qualitative-quantitative nature, that establishes the symptom within four levels; only one of which being validated (Teler scale). CONCLUSION The results of this study showed that, currently, there is only one scale that is validated for assessing odor in neoplastic wounds, pointing towards the need to develop new instruments that incorporate validated and reliable instruments in clinical practice.
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Affiliation(s)
| | - Nauã Rodrigues de Souza
- Universidade de Pernambuco, Nossa Senhora das Graças Nursing School. Recife, Pernambuco, Brazil
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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Freitas de Castro MC, Santos WAD, Fuly PDSC, Caldeira dos Santos MLS, Ribeiro Garcia T. Intervenções de enfermagem para pacientes oncológicos com odor fétido em ferida tumoral. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).
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Fuly PDSC, Pires LMV, Souza CQSD, Oliveira BGRBD, Padilha KG. Nursing workload for cancer patients under palliative care. Rev Esc Enferm USP 2017; 50:792-799. [PMID: 27982398 DOI: 10.1590/s0080-623420160000600012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 07/05/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload. METHOD This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care. RESULTS Analysis of 197 measures of the Nursing Activities Score (NAS) revealed a mean score of 43.09% and an association between the performance status of patients undergoing palliative care and the mean NAS scores. The results of the study point to the need to resize the team of the unit. CONCLUSION The NAS has proven to be a useful tool in oncologic clinical units for patients undergoing palliative care. OBJETIVO Verificar a carga de trabalho de enfermagem requerida por pacientes com câncer sob cuidados paliativos e possíveis associações entre as características demográficas e clínicas dos pacientes e a carga de trabalho de enfermagem. MÉTODO Trata-se de um estudo de abordagem quantitativa, transversal, prospectivo, desenvolvido na clínica de Tecido Ósseo Conectivo (TOC) da Unidade II do Instituto Nacional de Câncer José Alencar Gomes da Silva, com pacientes em cuidados paliativos. RESULTADOS A análise de 197 medidas do Nursing Activities Score (NAS) revelou um escore médio de 43,09% e uma associação entre a performance status de pacientes em cuidados paliativos com os valores médios do NAS. Os resultados do estudo apontam para a necessidade de redimensionamento da equipe da Unidade. CONCLUSÃO O NAS mostrou-se um instrumento passível de utilização em unidades clínicas oncológicas, com pacientes em cuidados paliativos.
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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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Edward KL, Ousey K. The role of resilience in rebuilding lives of injured veterans. J Wound Care 2016; 25:571-575. [PMID: 27681587 DOI: 10.12968/jowc.2016.25.10.571] [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: 11/11/2022]
Abstract
The aim of this commentary is to discuss potential clinical implications of introducing resilience-building interventions into care for veterans who are living with a war wound. Some war veterans are expected to live with a wound upon discharge from an active military role and also to fit into civilian life. These lifestyle adjustments can tax the person's coping abilities and in that context may hinder successful adaptation. The experience of living with a wound or wounds, either acute or chronic, is connected to losses, including loss of mobility, loss of financial capacity (unable to work at times) and losses attached to changed social roles. Psychological stress is also a common experience for veterans returning to civilian life. Psychological stress is associated with impaired wound healing. Modern health practice is centred on symptom reduction and working with pathology, however, working with people's adaptive behaviours such as resilience has not been considered. Using the resilience model as a conceptual framework health-care professionals can engage with veterans towards resilience within the context of their personal experience of ill health. Using this contemporary framework for considering these aspects of care has the potential to facilitate resistance to stressors associated with being injured, possibly preventing quality-of-life impairments. DECLARATION OF INTEREST There are no declarations of interest.
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Affiliation(s)
- K-L Edward
- Faculty of Health Sciences, Australian Catholic University.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
| | - K Ousey
- Faculty of Health Sciences, Australian Catholic University.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
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Castro MCFD, Fuly PDSC, Garcia TR, Santos MLSCD. Subconjunto terminológico CIPE® para pacientes em cuidados paliativos com feridas tumorais malignas. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Desenvolver e validar um subconjunto terminológico, utilizando a Classificação Internacional para Prática de Enfermagem para pacientes em cuidados paliativos com feridas tumorais malignas. Métodos Estudo metodológico com revisão integrativa da literatura, que busca evidências empíricas relacionadas às feridas tumorais malignas e intervenções de enfermagem para manejo dos sintomas, nas bases de dados MEDLINE, CINAHL, LILACS e COCHRANE, recorte temporal de 2002 a 2015. Após cruzamento das evidências com termos da CIPE® 2013, baseado no Modelo 7 Eixos, foram elaboradas declarações de diagnósticos e intervenções de enfermagem, distribuídas de acordo com necessidades humanas básicas do referencial conceitual de Wanda Horta e avaliadas por peritos. Resultados Das 51 afirmativas de diagnósticos e 134 intervenções de enfermagem, 84,31% e 91,04% foram validadas respectivamente, sendo elaborado o subconjunto. Conclusão O instrumento poderá constituir-se numa referência de fácil acesso para enfermeiros, propiciando um cuidado da ferida baseado em evidências e linguagem de enfermagem unificada.
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Leadbeater M. Assessment and treatment of fungating, malodorous wounds. Br J Community Nurs 2016; 21 Suppl 3:S6-S10. [PMID: 26940736 DOI: 10.12968/bjcn.2016.21.sup3.s6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Leadbeater
- Community Palliative Nurse Specialist, Ashgate Hospice, Chesterfield, England
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Rowan S, Moffatt C, Olden A. Researching the lived experiences of cancer patients with malignant fungating wounds. Int J Palliat Nurs 2015; 21:579-85. [PMID: 26707486 DOI: 10.12968/ijpn.2015.21.12.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Researching the experiences of terminally ill patients with disfiguring wounds is likely to be a challenge anywhere, and this investigation came face-to-face with different attitudes on the part of both patients and nurses and doctors in England (the South-East) and Italy (Tuscany). AIM To highlight the complexity of researching sensitive subjects and the difficulties encountered from the perspective of the researcher(s). METHODS Some 14 patients were interviewed. In England access was relatively straightforward, with nurses linked to the hospice doing most of the recruitment. Access was more difficult in Italy, with some doctors expressing opposition. DISCUSSION How ethical is it to treat dying patients as subjects for research? How does research of this kind vary from one culture to another? CONCLUSIONS Interviewees can find it therapeutic to talk about their experiences to a sympathetic listener--although the listening does pose a considerable strain on the researcher.
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Affiliation(s)
| | - Christine Moffatt
- Professor of Clinical Nursing Research at the University of Nottingham
| | - Anthony Olden
- Academic Lead for Research Students and Associate Professor, University of West London
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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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Ousey K, Edward KL. Exploring Resilience When Living with a Wound - An Integrative Literature Review. Healthcare (Basel) 2014; 2:346-55. [PMID: 27429282 PMCID: PMC4934596 DOI: 10.3390/healthcare2030346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/10/2014] [Accepted: 08/26/2014] [Indexed: 01/13/2023] Open
Abstract
The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound.
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Affiliation(s)
- Karen Ousey
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
| | - Karen-Leigh Edward
- Faculty of Health Sciences, Australian Catholic University, Locked Bag 4115 Fitzroy MDC, Victoria 3065, Australia.
- Nursing Research Unit, St Vincent's Private Hospital Melbourne, 59-61 Victoria Pde Fitzroy, Victoria 3065, Australia.
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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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Meanings and experiential outcomes of bodily care in a specialist palliative context. Palliat Support Care 2014; 13:625-33. [PMID: 24762673 DOI: 10.1017/s147895151400025x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to enhance the depth of existing knowledge about meanings and experiential outcomes of bodily care in the context of an inpatient specialist palliative setting. METHOD Interpretative phenomenology was chosen as the study sought to explore individuals' lived experiences related to bodily care. Nine participants (five women, four men) of various ages and with various metastasized cancers and bodily-care needs, all from one specialist palliative care ward, participated. Data were collected with repeated narrative interviews and supplementary participating observations. Analysis was informed by van Manen's approach. RESULTS The following meanings and experiential outcomes of bodily care were revealed by our study: maintaining and losing body capability, breaching borders of bodily integrity, being comforted and relieved in bodily-care situations, and being left in distress with unmet needs. These meanings overlap and shape the nature of each other and involve comforting and distressing experiences related to what can be described as conditional dimensions: the particular situation, one's own experiences of the body, and healthcare professionals' approaches. SIGNIFICANCE OF RESULTS The results, based on specialist palliative care patients' experiences, outline the meanings and outcomes that relate to the quintessence and complexity of palliative care, deriving from dying persons' blend of both basic and symptom-oriented bodily-care needs. Moreover, the results outline how these two dimensions of care equally influence whether comfort and well-being are facilitated or not. Considering this, specialist palliative care may consider how to best integrate and acknowledge the value of skilled basic nursing care as part of and complementary to expertise in symptom relief during the trajectories of illness and dying.
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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, Huljev D. The effective management of wounds with high levels of exudate. ACTA ACUST UNITED AC 2013; 22:S34. [DOI: 10.12968/bjon.2013.22.sup4.s34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sebastian Probst
- Zurich University of Applied Sciences, Institute of Nursing, Winterthur, Switzerland
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