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Manzo Margiotta F, Michelucci A, Fidanzi C, Granieri G, Salvia G, Bevilacqua M, Janowska A, Dini V, Romanelli M. Monoclonal Antibodies in the Management of Inflammation in Wound Healing: An Updated Literature Review. J Clin Med 2024; 13:4089. [PMID: 39064129 DOI: 10.3390/jcm13144089] [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: 05/25/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Chronic wounds pose a significant clinical challenge due to their complex pathophysiology and the burden of long-term management. Monoclonal antibodies (mAbs) are emerging as a novel therapeutic option in managing difficult wounds, although comprehensive data on their use in wound care are lacking. This study aimed to explore existing scientific knowledge of mAbs in treating chronic wounds based on a rationale of direct inhibition of the main molecules involved in the underlying inflammatory pathophysiology. We performed a literature review excluding primary inflammatory conditions with potential ulcerative outcomes (e.g., hidradenitis suppurativa). mAbs were effective in treating wounds from 16 different etiologies. The most commonly treated conditions were pyoderma gangrenosum (treated with 12 different mAbs), lipoid necrobiosis, and cutaneous vasculitis (each treated with 3 different mAbs). Fourteen mAbs were analyzed in total. Rituximab was effective in 43.75% of cases (7/16 diseases), followed by tocilizumab (25%, 4/16 diseases), and both etanercept and adalimumab (18.75%, 3/16 conditions each). mAbs offer therapeutic potential for chronic wounds unresponsive to standard treatments. However, due to the complex molecular nature of wound healing, no single target molecule can be identified. Therefore, the use of mAbs should be considered as a translational approach for limited cases of multi-resistant conditions.
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Affiliation(s)
- Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
- Interdisciplinary Center of Health Science, Sant'Anna School of Advanced Studies of Pisa, 56127 Pisa, Italy
| | - Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
- Interdisciplinary Center of Health Science, Sant'Anna School of Advanced Studies of Pisa, 56127 Pisa, Italy
| | | | | | - Giorgia Salvia
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
| | | | - Agata Janowska
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy
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Abdo AI, Kopecki Z. Comparing Redox and Intracellular Signalling Responses to Cold Plasma in Wound Healing and Cancer. Curr Issues Mol Biol 2024; 46:4885-4923. [PMID: 38785562 PMCID: PMC11120013 DOI: 10.3390/cimb46050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Cold plasma (CP) is an ionised gas containing excited molecules and ions, radicals, and free electrons, and which emits electric fields and UV radiation. CP is potently antimicrobial, and can be applied safely to biological tissue, birthing the field of plasma medicine. Reactive oxygen and nitrogen species (RONS) produced by CP affect biological processes directly or indirectly via the modification of cellular lipids, proteins, DNA, and intracellular signalling pathways. CP can be applied at lower levels for oxidative eustress to activate cell proliferation, motility, migration, and antioxidant production in normal cells, mainly potentiated by the unfolded protein response, the nuclear factor-erythroid factor 2-related factor 2 (Nrf2)-activated antioxidant response element, and the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway, which also activates nuclear factor-kappa B (NFκB). At higher CP exposures, inactivation, apoptosis, and autophagy of malignant cells can occur via the degradation of the PI3K/Akt and mitogen-activated protein kinase (MAPK)-dependent and -independent activation of the master tumour suppressor p53, leading to caspase-mediated cell death. These opposing responses validate a hormesis approach to plasma medicine. Clinical applications of CP are becoming increasingly realised in wound healing, while clinical effectiveness in tumours is currently coming to light. This review will outline advances in plasma medicine and compare the main redox and intracellular signalling responses to CP in wound healing and cancer.
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Affiliation(s)
- Adrian I. Abdo
- Richter Lab, Surgical Specialties, Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Department of Surgery, The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Zlatko Kopecki
- Future Industries Institute, STEM Academic Unit, University of South Australia, Mawson Lakes, SA 5095, Australia
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Townsend EC, Cheong JZA, Radzietza M, Fritz B, Malone M, Bjarnsholt T, Ousey K, Swanson T, Schultz G, Gibson ALF, Kalan LR. What is slough? Defining the proteomic and microbial composition of slough and its implications for wound healing. Wound Repair Regen 2024. [PMID: 38558438 DOI: 10.1111/wrr.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Slough is a well-known feature of non-healing wounds. This pilot study aims to determine the proteomic and microbiologic components of slough as well as interrogate the associations between wound slough components and wound healing. Ten subjects with slow-to-heal wounds and visible slough were enrolled. Aetiologies included venous stasis ulcers, post-surgical site infections and pressure ulcers. Patient co-morbidities and wound healing outcome at 3-months post-sample collection was recorded. Debrided slough was analysed microscopically, through untargeted proteomics, and high-throughput bacterial 16S-ribosomal gene sequencing. Microscopic imaging revealed wound slough to be amorphous in structure and highly variable. 16S-profiling found slough microbial communities to associate with wound aetiology and location on the body. Across all subjects, slough largely consisted of proteins involved in skin structure and formation, blood-clot formation and immune processes. To predict variables associated with wound healing, protein, microbial and clinical datasets were integrated into a supervised discriminant analysis. This analysis revealed that healing wounds were enriched for proteins involved in skin barrier development and negative regulation of immune responses. While wounds that deteriorated over time started off with a higher baseline Bates-Jensen Wound Assessment Score and were enriched for anaerobic bacterial taxa and chronic inflammatory proteins. To our knowledge, this is the first study to integrate clinical, microbiome, and proteomic data to systematically characterise wound slough and integrate it into a single assessment to predict wound healing outcome. Collectively, our findings underscore how slough components can help identify wounds at risk of continued impaired healing and serves as an underutilised biomarker.
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Affiliation(s)
- Elizabeth C Townsend
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - J Z Alex Cheong
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael Radzietza
- Infectious Diseases and Microbiology, Western Sydney University, Sydney, Australia
| | - Blaine Fritz
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Malone
- Infectious Diseases and Microbiology, Western Sydney University, Sydney, Australia
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- International Wound Infection Institute, London, UK
| | - Karen Ousey
- International Wound Infection Institute, London, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, West Yorkshire, UK
| | | | - Gregory Schultz
- International Wound Infection Institute, London, UK
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lindsay R Kalan
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- International Wound Infection Institute, London, UK
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Ontario, Canada
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Stevenson EM, Coda A, Bourke MDJ. Investigating low rates of compliance to graduated compression therapy for chronic venous insufficiency: A systematic review. Int Wound J 2024; 21:e14833. [PMID: 38522455 PMCID: PMC10961173 DOI: 10.1111/iwj.14833] [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: 12/14/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.
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Affiliation(s)
- Elise M. Stevenson
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
| | - Michael D. J. Bourke
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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Tiang T, Behrenbruch C, Noori J, Lam D, Bhamidipaty M, Johnston M, Woods R, D'Souza B. Prophylactic negative pressure wound therapy to improve wound healing rates following ileostomy closure: a randomized controlled trial. ANZ J Surg 2024. [PMID: 38525845 DOI: 10.1111/ans.18941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse-string suture. METHODS This was a dual-centre, open-label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient-reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI). RESULTS The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient- reported wound cosmesis or SSI. CONCLUSION There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse-string suture.
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Affiliation(s)
- Thomas Tiang
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Corina Behrenbruch
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Clinical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jawed Noori
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Lam
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Madhu Bhamidipaty
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Johnston
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Rodney Woods
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Basil D'Souza
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Premarathna AD, Ahmed TAE, Rjabovs V, Hammami R, Critchley AT, Tuvikene R, Hincke MT. Immunomodulation by xylan and carrageenan-type polysaccharides from red seaweeds: Anti-inflammatory, wound healing, cytoprotective, and anticoagulant activities. Int J Biol Macromol 2024; 260:129433. [PMID: 38232891 DOI: 10.1016/j.ijbiomac.2024.129433] [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: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
The immunomodulatory properties of the polysaccharides (carrageenan, xylan) from Chondrus crispus (CC), Ahnfeltiopsis devoniensis (AD), Sarcodiotheca gaudichaudii (SG) and Palmaria palmata (PP) algal species were studied. Using RAW264.7 macrophages, we investigated the proliferation and migration capacity of different extracts along with their immunomodulatory activities, including nitric oxide (NO) production, phagocytosis, and secretion of pro-inflammatory cytokines. Polysaccharides from C. crispus and S. gaudichaudii effectively mitigated inflammation and improved scratch-wound healing. Polysaccharide fractions extracted under cold conditions (25 °C), including CC-1A, SG-1A and SG-1B stimulated cell proliferation, while fractions extracted under hot conditions (95 °C), including CC-3A, CC-2B and A. devoniensis (AD-3A), inhibited cell proliferation after 48 h. Furthermore, RAW264.7 cells treated with the fractions CC-3A, AD-1A, and SG-2A significantly reduced LPS-stimulated NO secretion over 24 h. Phagocytosis was significantly improved by treatment with C. crispus (CC-2B, CC-3B) and A. devoniensis (AD-3A) fractions. RAW264.7 cells treated with the CC-2A and SG-1A fractions showed elevated TGF-β1 expression without affecting TNF-α expression at 24 h. Polysaccharide fractions of A. devoniensis (ι/κ hybrid carrageenan; AD-2A, AD-3A) showed the highest anti-coagulation activity. CC-2A and SG-1A fractions enhanced various bioactivities, suggesting they are candidates for skin-health applications. The carrageenan fractions (CC-3A: λ-, μ-carrageenan, SG-2A: ν-, ι-carrageenan) tested herein showed great potential for developing anti-inflammatory and upscaled skin-health applications.
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Affiliation(s)
- Amal D Premarathna
- School of Natural Sciences and Health, Tallinn University, Narva mnt 29, 10120 Tallinn, Estonia.
| | - Tamer A E Ahmed
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ontario K1H 8M5, Canada; School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ontario K1H 8M5, Canada
| | - Vitalijs Rjabovs
- National Institute of Chemical Physics and Biophysics, Akadeemia tee 23, 12618 Tallinn, Estonia; Institute of Technology of Organic Chemistry, Riga Technical University, Paula Valdena iela 3/7, LV-1048 Riga, Latvia
| | - Riadh Hammami
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ontario K1H 8M5, Canada
| | - Alan T Critchley
- Verschuren Centre for Sustainability in Energy and Environment, Sydney, NS B1M 1A2, Canada
| | - Rando Tuvikene
- School of Natural Sciences and Health, Tallinn University, Narva mnt 29, 10120 Tallinn, Estonia.
| | - Maxwell T Hincke
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ontario K1H 8M5, Canada; Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ontario K1H 8M5, Canada.
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Queen D, Harding K. Estimating the cost of wounds both nationally and regionally within the top 10 highest spenders. Int Wound J 2024; 21:e14709. [PMID: 38379224 PMCID: PMC10830400 DOI: 10.1111/iwj.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 02/22/2024] Open
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Vyas HK, Xia B, Alam D, Gracie NP, Rothwell JG, Rice SA, Carter D, Cullen PJ, Mai-Prochnow A. Plasma activated water as a pre-treatment strategy in the context of biofilm-infected chronic wounds. Biofilm 2023; 6:100154. [PMID: 37771391 PMCID: PMC10522953 DOI: 10.1016/j.bioflm.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Healing and treatment of chronic wounds are often complicated due to biofilm formation by pathogens. Here, the efficacy of plasma activated water (PAW) as a pre-treatment strategy has been investigated prior to the application of topical antiseptics polyhexamethylene biguanide, povidone iodine, and MediHoney, which are routinely used to treat chronic wounds. The efficacy of this treatment strategy was determined against biofilms of Escherichia coli formed on a plastic substratum and on a human keratinocyte monolayer substratum used as an in vitro biofilm-skin epithelial cell model. PAW pre-treatment greatly increased the killing efficacy of all the three antiseptics to eradicate the E. coli biofilms formed on the plastic and keratinocyte substrates. However, the efficacy of the combined PAW-antiseptic treatment and single treatments using PAW or antiseptic alone was lower for biofilms formed in the in vitro biofilm-skin epithelial cell model compared to the plastic substratum. Scavenging assays demonstrated that reactive species present within the PAW were largely responsible for its anti-biofilm activity. PAW treatment resulted in significant intracellular reactive oxygen and nitrogen species accumulation within the E. coli biofilms, while also rapidly acting on the microbial membrane leading to outer membrane permeabilisation and depolarisation. Together, these factors contribute to significant cell death, potentiating the antibacterial effect of the assessed antiseptics.
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Affiliation(s)
- Heema K.N. Vyas
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, Australia
- The Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia
| | - Binbin Xia
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - David Alam
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas P. Gracie
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna G. Rothwell
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Scott A. Rice
- Agriculture and Food, Microbiomes for One Systems Health, Commonwealth Scientific and Industrial Research Organisation, Sydney, New South Wales, Australia
- The Australian Institute for Microbiology and Infection, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dee Carter
- The Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrick J. Cullen
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Mai-Prochnow
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, Australia
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Cheung DH, Schneider CR, Um IS. The role of community pharmacy in wound care: a scoping review. J Wound Care 2023; 32:728-737. [PMID: 37907355 DOI: 10.12968/jowc.2023.32.11.728] [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: 11/02/2023]
Abstract
OBJECTIVE To scope the literature describing the role of pharmacy in wound care in the community setting. METHOD A systematic scoping review was conducted including peer-reviewed and grey literature. A search was undertaken using CINAHL, Embase, Informit, International Pharmaceutical Abstracts and MEDLINE, and a Google search of the top 200 results via three virtual private networks were used to identify relevant grey literature. Keywords relating to pharmacy, pharmacist, wound, wound management and wound care were used. Descriptions of wound care activities were extracted, grouped by similarity, and mapped to the International Pharmaceutical Federation's (FIP) Global Competency Framework Version 2 (GbCFv2). RESULTS Of 2928 potentially relevant articles and 600 web search results, 55 articles from the database search and 11 results from the Google search met the eligibility criteria. After mapping 14 identified roles to the FIP GbCFv2, it was apparent that the scope of practice for wound care spanned across all four competency domains: pharmaceutical public health; pharmaceutical care; professional/personal; and organisational and management. CONCLUSION The role of community pharmacy in wound care is multifaceted and within the scope of entry-level competency for pharmacists. These roles comprise wound related and non-wound-specific, clinical and non-clinical activities.
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Affiliation(s)
- Daisy Hk Cheung
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Carl R Schneider
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Irene S Um
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Huang Y, Hu J, Xie T, Jiang Z, Ding W, Mao B, Hou L. Effects of home-based chronic wound care training for patients and caregivers: A systematic review. Int Wound J 2023; 20:3802-3820. [PMID: 37277908 PMCID: PMC10588341 DOI: 10.1111/iwj.14219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
We aimed to review and synthesise the evidence of the interventions of patients' and informal caregivers' engagement in managing chronic wounds at home. The research team used a systematic review methodology based on an updated guideline for reporting systematic reviews (PRISMA) and recommendations from the Synthesis Without Meta-analysis. Cochrane Central Register of Controlled Trial of the Cochrane Library, Pubmed, Embase, CINAHL, Wanfang (Chinese), and CNKI database (Chinese) were searched from inception to May 2022. The following MESH terms were used: wound healing, pressure ulcer, leg ulcer, diabetic foot, skin ulcer, surgical wound, educational, patient education, counselling, self-care, self-management, social support, and family caregiver. Experimental studies involving participants with chronic wounds (not at risk of wounds) and their informal caregivers were screened. Data were extracted and the narrative was synthesised from the findings of included studies. By screening the above databases, 790 studies were retrieved, and 16 met the inclusion and exclusion criteria. Studies were 6 RCTs and ten non-RCTs. Outcomes of chronic wound management included patient indicators, wound indicators, and family/caregiver indicators. Home-based interventions of patients or informal caregivers' engagement in managing chronic wounds at home may effectively improve patient outcomes and change wound care behaviour. What's more, educational/behavioural interventions were the primary type of intervention. Multiform integration of education and skills training on wound care and aetiology-based treatment was delivered to patients and caregivers. Besides, there are no studies entirely targeting elderly patients. Home-based chronic wound care training was important to patients with chronic wounds and their family caregivers, which may advance wound management outcomes. However, the findings of this systematic review were based on relatively small studies. We need more exploration of self and family-oriented interventions in the future, especially for older people affected by chronic wounds.
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Affiliation(s)
- Yao Huang
- Wound Healing Center at Emergency DepartmentNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of GraduateShanghai Jiao Tong University School of NursingShanghaiChina
| | - Jiale Hu
- Department of Nurse AnesthesiaVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ting Xie
- Wound Healing Center at Emergency DepartmentNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhaoqi Jiang
- Wound Healing Center at Emergency DepartmentNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenjing Ding
- Department of libraryShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Beiqian Mao
- Wound Healing Center at Emergency DepartmentNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lili Hou
- Nursing DepartmentNinth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Probst S, Saini C, Gschwind G, Stefanelli A, Bobbink P, Pugliese M, Cekic S, Pastor D, Gethin G. Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis. Int Wound J 2023; 20:3906-3921. [PMID: 37293810 PMCID: PMC10588327 DOI: 10.1111/iwj.14272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.
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Affiliation(s)
- Sebastian Probst
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Care DirectorateUniversity Hospital GenevaGeneva University HospitalsGenevaSwitzerland
- Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
| | - Camille Saini
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Géraldine Gschwind
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Alessio Stefanelli
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Paul Bobbink
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- Faculty of Biology and Medicine, University Institute of Higher Education and Research in HealthcareUniversity of LausanneLausanneSwitzerland
| | - Marie‐Thérèse Pugliese
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
| | - Sezen Cekic
- Department of PsychologyUniversity of GenevaGenevaSwitzerland
| | - Damien Pastor
- Department of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | - Georgina Gethin
- Geneva School of Health ScienceHES‐SO University of Applied Sciences and Arts, Western SwitzerlandGenevaSwitzerland
- College of Medicine Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Alliance for Research and Innovation in WoundsUniversity of GalwayGalwayIreland
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12
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Vangaveti VN, Jhamb S, Goodall J, Bulbrook J, Biros E, Malabu UH. Extracorporeal Shockwave Therapy (ESWT) in the Management of Diabetic Foot Ulcer: A Prospective Randomized Clinical Trial. J Foot Ankle Surg 2023; 62:845-849. [PMID: 37164252 DOI: 10.1053/j.jfas.2023.04.013] [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: 04/20/2021] [Revised: 03/19/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
Diabetic foot ulcer (DFU) is the most common cause of prolonged hospitalization with a high cost of care due to unsatisfactory outcomes with the current mode of therapy. Extracorporeal shockwave therapy (ESWT) is a new technology in the care of nonhealing wounds. The study's main objective was to compare the healing parameters of DFUs between patients undergoing the standard of care (SOC) alone and ESWT + SOC. The secondary objective was to assess inflammatory markers in both study groups. The study was designed as a single-center, randomized trial to provide evidence on the effects of ESWT on DFU healing. Informed consent was obtained from all participants before enrolment. Forty-eight participants were recruited, enrolled, and randomly allocated into the 2 study groups. Twenty-five patients were allocated to the ESWT + SOC group, and 23 patients were allocated into the SOC-only group for a treatment period of 6 weeks. The univariate binary analysis showed more patients with healed DFU in the ESWT + SOC group than the SOC-only group at 6 weeks, though the difference did not reach statistical significance (OR = 3.2, p = .07). The adjusted multivariate binary analysis confirmed this finding; however, the effect size did not reach statistical significance at 6 weeks (OR = 3.9, p = .08). The level of circulating inflammatory markers was similar in both groups of patients. It is the author's opinion that there is a potential benefit of ESWT on diabetic wound healing with further research warranted to determine its role in treatment of DFU. A larger trial with a more extended treatment period is, however, needed to substantiate our findings.
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Affiliation(s)
- Venkat N Vangaveti
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | - Shaurya Jhamb
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia; Department of Endocrinology & Diabetes, Townsville University Hospital, Townsville, Queensland, Australia
| | - Julie Goodall
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia; Department of Endocrinology & Diabetes, Townsville University Hospital, Townsville, Queensland, Australia
| | - Jacqueline Bulbrook
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia; Department of Endocrinology & Diabetes, Townsville University Hospital, Townsville, Queensland, Australia
| | - Erik Biros
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | - Usman H Malabu
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia; Department of Endocrinology & Diabetes, Townsville University Hospital, Townsville, Queensland, Australia.
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13
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Sussman G. An update on wound management. Aust Prescr 2023; 46:29-35. [PMID: 38053564 PMCID: PMC10664094 DOI: 10.18773/austprescr.2023.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Wound management involves an understanding of the aetiology and pathophysiology of a wound, the healing process and how best to manage both. Acute wounds can occur suddenly, such as burns and skin tears. Chronic wounds fail to progress through the normal stages of healing and can include ulcers, pressure injuries and infected wounds. Dressings and bandages provide the optimal environment for the healing of all wound types. It is important for healthcare practitioners to understand the key differences in their properties, uses and precautions. Selecting the ideal dressing or bandage can minimise the healing duration, reduce the bioburden, and improve a patient's quality of life.
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Affiliation(s)
- Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University
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14
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Graves N, Maiti R, Aloweni FAB, Yi Zhen N, Yuh AS, Bishnoi P, Chong TT, Carmody D, Harding K. Retrospective matched cohort study of incidence rates and excess length of hospital stay owing to pressure injuries in an Asian setting. HEALTH CARE SCIENCE 2023; 2:82-93. [PMID: 38938768 PMCID: PMC11080845 DOI: 10.1002/hcs2.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 06/29/2024]
Abstract
Background Little is known about stage 1 and 2 pressure injuries that are health care-acquired. We report incidence rates of health care-acquired stage 1 and stage 2 pressure injuries, and, estimate the excess length of stay using four competing analytic methods. We discuss the merits of the different approaches. Methods We calculated monthly incidence rates for stage 1 and 2 health care-acquired pressure injuries occurring in a large Singapore acute care hospital. To estimate excess stay, we conducted unadjusted comparisons with a control cohort, performed linear regression and then generalized linear regression with a gamma distribution. Finally, we fitted a simple state-based model. The design for the cost attribution work was a retrospective matched cohort study. Results Incidence rates in 2016 were 0.553% (95% confidence interval [CI] 0.55, 0.557) and 0.469% (95% CI 0.466, 0.472) in 2017. For data censored at 60 days' maximum stay, the unadjusted comparisons showed the highest excess stay at 17.68 (16.43-18.93) days and multi-state models showed the lowest at 1.22 (0.19, 2.23) days. Conclusions Poor-quality methods for attribution of excess length of stay to pressure injury generate inflated estimates that could mislead decision makers. The findings from the multi-state model, which is an appropriate method, are plausible and illustrate the likely bed-days saved from lowering the risk of these events. Stage 1 and 2 pressure injuries are common and increase costs by prolonging the length of stay. There will be economic value investing in prevention. Using biased estimates of excess length of stay will overstate the potential value of prevention.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Raju Maiti
- Centre for Quantitative MedicineDuke‐NUS Medical SchoolSingaporeSingapore
| | | | - Ng Yi Zhen
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | | | - Priya Bishnoi
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | | | | | - Keith Harding
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
- Wound Care Innovation for the Tropics ProgrammeSingaporeSingapore
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15
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Recent Advances in Using Natural Antibacterial Additives in Bioactive Wound Dressings. Pharmaceutics 2023; 15:pharmaceutics15020644. [PMID: 36839966 PMCID: PMC10004169 DOI: 10.3390/pharmaceutics15020644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Wound care is a global health issue with a financial burden of up to US $96.8 billion annually in the USA alone. Chronic non-healing wounds which show delayed and incomplete healing are especially problematic. Although there are more than 3000 dressing types in the wound management market, new developments in more efficient wound dressings will require innovative approaches such as embedding antibacterial additives into wound-dressing materials. The lack of novel antibacterial agents and the misuse of current antibiotics have caused an increase in antimicrobial resistance (AMR) which is estimated to cause 10 million deaths by 2050 worldwide. These ongoing challenges clearly indicate an urgent need for developing new antibacterial additives in wound dressings targeting microbial pathogens. Natural products and their derivatives have long been a significant source of pharmaceuticals against AMR. Scrutinising the data of newly approved drugs has identified plants as one of the biggest and most important sources in the development of novel antibacterial drugs. Some of the plant-based antibacterial additives, such as essential oils and plant extracts, have been previously used in wound dressings; however, there is another source of plant-derived antibacterial additives, i.e., those produced by symbiotic endophytic fungi, that show great potential in wound dressing applications. Endophytes represent a novel, natural, and sustainable source of bioactive compounds for therapeutic applications, including as efficient antibacterial additives for chronic wound dressings. This review examines and appraises recent developments in bioactive wound dressings that incorporate natural products as antibacterial agents as well as advances in endophyte research that show great potential in treating chronic wounds.
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16
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Premarathna AD, Tuvikene R, Somasiri M, De Silva M, Adhikari R, Ranahewa TH, Wijesundara R, Wijesekera SK, Dissanayake I, Wangchuk P, Rjabovs V, Jayasooriya AP, Rajapakse R. A novel therapeutic effect of mannitol-rich extract from the brown seaweed Sargassum ilicifolium using in vitro and in vivo models. BMC Complement Med Ther 2023; 23:26. [PMID: 36721189 PMCID: PMC9887804 DOI: 10.1186/s12906-023-03840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wound healing is an active, complex, integrated series of cellular, physiological, and biochemical changes initiated by the stimulus of injury in a tissue. The present study was performed to investigate the potential wound healing abilities of Sargassum ilicifolium crude extracts (CE) that were characterized by 1H NMR and FTIR Spectrometric measurements. MATERIALS AND METHODS Seaweed samples were collected from southern coastal sites of Sri Lanka. To determine the cytotoxicity and proliferation of S. ilicifolium CE were used for the MTT and alamarBlue assays respectively. The scratch and exclusion wound models were used to HaCaT and HDF cells to assess the cell proliferation and migration. RAW 264.7 cells (macrophages) were used to evaluate Nitric Oxide (NO) production and phagocytosis activities. Moreover, Fifteen, 8-week-old, female, New Zealand rabbits were selected and divided into five groups: excision skin wounds (10.40 ± 0.60 mm) were induced in groups I, II, and III. Rabbits in groups I and IV were given S. ilicifolium CE (orally, 100 mg/kg day, two weeks), whereas groups II and V were given equal amounts of distilled water. Wound healing properties were measured and wound tissue samples were collated, formalin-fixed, wax-embedded, stained (Hematoxylin and Eosin; Van Gieson) and examined for the healing process. RESULTS Anti-inflammatory and wound healing activities were observed in RAW 264.7, HDF and HaCaT cells treated with S. ilicifolium aqueous extracts when compared to the control groups. S. ilicifolium extracts concentration 8 - 4 μg/μL, (P<0.05) had remarkable the highest proliferative and migratory effects on RAW 264.7, HDF and HaCaT cells when compared with the control. RAW 264.7 cell proliferation and/or migration were higher in S. ilicifolium extracts (4 μg/μL, 232.8 ± 10.07%) compared with the control (100 %). Scratch wound healing were remarkably enhanced in 24 h, 48 h (P<0.05) when treated with S. ilicifolium on HaCaT cells. Rabbits treated with the CE of S. ilicifolium showed a significantly increased wound healing activities (P<0.05) within three days with a close wound area of 57.21 ± 0.77 % compared with control group (26.63 ± 1.09 %). Histopathology, aspartate aminotransferase and alanine aminotransferase levels evidenced no toxic effects on seaweed treated groups. Histopathological results also revealed that the healing process was significantly faster in the rabbit groups which were as treated with CE of S. ilicifolium orally with the evidence of enhanced early granulation tissue (connective tissue and angiogenesis) and significant epithelization compared to the control. CONCLUSIONS Cell proliferation and migration are significantly faster when treated with S. ilicifolium aqueous extracts. Moreover, there are no toxic effect of S. ilicifolium aqueous extracts on RAW 264.7, HDF and HaCaT cell lines. In this study, it is revealed that S. ilicifolium has potential remedial agent; D-Mannitol for skin wound healing properties that by promote keratinocyte and fibroblast proliferation and migration. These findings show that S. ilicifolium have promising wound healing properties.
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Affiliation(s)
- Amal D Premarathna
- School of Natural Sciences and Health, Tallinn University, Narva mnt 29, 10120, Tallinn, Estonia.
| | - Rando Tuvikene
- School of Natural Sciences and Health, Tallinn University, Narva mnt 29, 10120, Tallinn, Estonia.
| | - Mnr Somasiri
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mlwp De Silva
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjith Adhikari
- South Asian Clinical Toxicology Research Collaboration. Faculty of Medicine, National Serpentarium, University of Peradeniya, Peradeniya, Sri Lanka
| | - T H Ranahewa
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rrmkk Wijesundara
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - S K Wijesekera
- Department of Zoology, Faculty of Natural Sciences, Open University, Kandy Regional Center, Polgolla, Sri Lanka
| | - Ipghu Dissanayake
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Phurpa Wangchuk
- Centre for Molecular Therapeutics, Australian Institute of Tropical health and Medicine, James Cook University, Smithfield, QLD, 4878, Australia
| | - Vitalijs Rjabovs
- National Institute of Chemical Physics and Biophysics, Akadeemia tee 23, 12618, Tallinn, Estonia
| | - Anura P Jayasooriya
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rpvj Rajapakse
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka.
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17
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Development of an implantable three-dimensional model of a functional pathogenic multispecies biofilm to study infected wounds. Sci Rep 2022; 12:21846. [PMID: 36528648 PMCID: PMC9759537 DOI: 10.1038/s41598-022-25569-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Chronic wounds cannot heal due to impairment of regeneration, mainly caused by the persistent infection of multispecies biofilms. Still, the effects of biofilm wound infection and its interaction with the host are not fully described. We aimed to study functional biofilms in physiological conditions in vitro, and their potential effects in health and regeneration in vivo. Therefore, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis were seeded in collagen-based scaffolds for dermal regeneration. After 24 h, scaffolds had bacterial loads depending on the initial inoculum, containing viable biofilms with antibiotic tolerance. Afterwards, scaffolds were implanted onto full skin wounds in mice, together with daily supervision and antibiotic treatment. Although all mice survived their health was affected, displaying fever and weight loss. After ten days, histomorphology of scaffolds showed high heterogeneity in samples and within groups. Wounds were strongly, mildly, or not infected according to colony forming units, and P. aeruginosa had higher identification frequency. Biofilm infection induced leucocyte infiltration and elevated interferon-γ and interleukin-10 in scaffolds, increase of size and weight of spleen and high systemic pro-calcitonin concentrations. This functional and implantable 3D biofilm model allows to study host response during infection, providing a useful tool for infected wounds therapy development.
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18
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Barakat‐Johnson M, Kita B, Jones A, Burger M, Airey D, Stephenson J, Leong T, Pinkova J, Frank G, Ko N, Kirk A, Frotjold A, White K, Coyer F. The viability and acceptability of a Virtual Wound Care Command Centre in Australia. Int Wound J 2022; 19:1769-1785. [PMID: 35607997 PMCID: PMC9615290 DOI: 10.1111/iwj.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7 months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5 hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.
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Affiliation(s)
- Michelle Barakat‐Johnson
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Badia Kita
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Aaron Jones
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
| | - Mitchell Burger
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
- Information Communication Technology, Strategy Architecture and Innovation, Sydney Local Health DistrictSydneyNew South WalesAustralia
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - David Airey
- Riverina EndovascularWagga WaggaNew South WalesAustralia
| | - John Stephenson
- Biomedical StatisticsSchool of Human and Health Services, University of HuddersfieldHuddersfieldUnited Kingdom
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
| | - Thomas Leong
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jana Pinkova
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Georgina Frank
- Podiatry DepartmentSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Natalie Ko
- Department of Nursing and MidwiferyConcord HospitalSydneyNew South WalesAustralia
| | - Andrea Kirk
- Nursing and Midwifery ServicesWestern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Astrid Frotjold
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Kate White
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSWSydneyNew South WalesAustralia
| | - Fiona Coyer
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
- Intensive Care ServicesRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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19
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Nazeha N, Lee JY, Saffari SE, Meng L, Ho P, Ng YZ, Graves N. The burden of costs on health services from patients with venous leg ulcers in Singapore. Int Wound J 2022; 20:845-852. [PMID: 36098383 PMCID: PMC9927897 DOI: 10.1111/iwj.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.
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Affiliation(s)
- Nuraini Nazeha
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - Jia Yi Lee
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - Lingyan Meng
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Pei Ho
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Yi Zhen Ng
- Wound Care Innovation for the Tropics ProgrammeSkin Research Institute of Singapore, A*STARSingapore
| | - Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
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20
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Ngoepe MP, Battison A, Mufamadi S. Nano-Enabled Chronic Wound Healing Strategies: Burn and Diabetic Ulcer Wounds. J Biomed Nanotechnol 2022. [DOI: 10.1166/jbn.2022.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The human skin serves as the body’s first line of defense against the environment. Diabetes mellitus (DM) and 2nd–4th degree burns, on the other hand, affect the skin’s protective barrier features. Burn wounds, hypermetabolic state, and hyperglycemia compromise the
immune system leading to chronic wound healing. Unlike acute wound healing processes, chronic wounds are affected by reinfections which can lead to limb amputation or death. The conventional wound dressing techniques used to protect the wound and provide an optimal environment for repair have
their limitations. Various nanomaterials have been produced that exhibit distinct features to tackle issues affecting wound repair mechanisms. This review discusses the emerging technologies that have been designed to improve wound care upon skin injury. To ensure rapid healing and possibly
prevent scarring, different nanomaterials can be applied at different stages of healing (hemostasis, inflammation, proliferation, remodeling).
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Affiliation(s)
- Mpho Phehello Ngoepe
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Aidan Battison
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Steven Mufamadi
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
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21
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Guest JF, Deanesi V, Segalla A. Cost-effectiveness of Debrichem in managing hard-to-heal venous leg ulcers in the UK. J Wound Care 2022; 31:480-491. [PMID: 35678784 DOI: 10.12968/jowc.2022.31.6.480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To estimate whether the topical debriding agent, Debrichem, could potentially afford the UK's National Health Service (NHS) a cost-effective intervention for the management of hard-to-heal venous leg ulcers (VLUs). METHOD A Markov model was constructed depicting the management of hard-to-heal VLUs with Debrichem plus standard care (SC) or SC alone over a period of 12 months. The model was populated with inputs from an indirect comparison of two propensity score-matched cohorts. The model estimated the cost-effectiveness of the two interventions in terms of the incremental cost per quality-adjusted life year (QALY) gained at 2019/20 prices. RESULTS Addition of Debrichem to a SC protocol to treat hard-to-heal VLUs was found to increase the probability of healing by 75% (from 0.35 to 0.61) by 12 months, and to increase health-related quality of life over 12 months from 0.74 to 0.84 QALYs per patient. The 12-month cost of treatment with Debrichem plus SC (£3128 per patient) instead of SC alone (£7195 per patient) has the potential to reduce the total NHS cost of wound management by up to 57%. Hence, Debrichem was estimated to improve health outcomes for less cost. Sensitivity analysis showed that Debrichem plus SC remained a cost-effective (dominant) treatment with plausible variations in costs and effectiveness. CONCLUSION Within the limitations of the study, the addition of Debrichem to a SC protocol potentially affords a cost-effective treatment to the NHS for managing hard-to-heal VLUs.
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22
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Ruíz-Antúnez E, Nieto-García A, Alonso-Sardón M. Clinical Burden of Inpatient Wound Care in Internal Medicine Units During the First Wave of COVID-19 Outbreak. Adv Skin Wound Care 2022; 35:1-7. [PMID: 35426846 DOI: 10.1097/01.asw.0000824564.25976.c8] [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: 01/28/2023]
Abstract
OBJECTIVE To explore the clinical burden and epidemiologic profile of hospitalized patients with wounds during the first wave of COVID-19. METHODS A retrospective and observational study was conducted to analyze the inpatient episodes of wound care in the University Hospital of Salamanca (Spain) during the initial COVID-19 crisis from March 1, 2020, to June 1, 2020. Data were collected from nursing care reports and clinical discharge reports. Included patients were 18 years or older, had a hospital length of stay of 1 day or longer, and were hospitalized in an internal medicine unit. Surgical and traumatic wounds and pediatric patients were excluded. RESULTS A total of 116 patients and 216 wounds were included. The overall wound prevalence was 7.6%, and incidence was 3.5% in the internal medicine units. Pressure injuries (PIs) were the most common wound type, and patients with COVID-19 had significantly higher PI risk (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-4.0; P = .042). Significant differences in PI staging were noted: 83.2% of wounds in patients with COVID-19 were stages I-II versus 67.8% in patients without COVID-19; the probability of stage III-IV PIs among patients without COVID-19 was doubled (OR, 2.3; 95% CI, 1.2-4.5; P = .009). The probability of acute wounds tripled in patients with COVID-19 (OR, 3.7; 95% CI, 2.1-6.6; P < .001). Patients with COVID-19 also had longer mean hospital stays and higher ICU admission rates. No case fatality rate differences were observed. CONCLUSIONS In this context of clinical practice, protocolized assessment and implementation of preventive measures must be ensured among older adult populations, patients with associated comorbidities, and ICU patients.
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Affiliation(s)
- Leticia Nieto-García
- Leticia Nieto-García, RN, PT, is PhD Student and Research Nurse, Institute for Biomedical Research of Salamanca, Spain. At the University Hospital of Salamanca, Adela Carpio-Perez, MD, PhD, is Internal Medicine Physician; Maria Teresa Moreiro-Barroso, MD, is Internal Medicine Physician; Emilia Ruíz-Antúnez, RN, is Nurse, Department of Training, Development and Innovation; and Ainhoa Nieto-García, is Social Worker and Nursing Student. Montserrat Alonso-Sardón, MD, PhD, MPH, is Full Professor of Preventive Medicine, Epidemiology and Public Health, University of Salamanca. The authors have disclosed no financial relationships related to this article. Submitted June 24, 2021; accepted in revised form November 2, 2021; published online ahead of print April 15, 2022
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Abstract
OBJECTIVE To explore the factors influencing quality of life in patients with chronic wounds. METHODS A total of 138 patients with chronic wounds were included and completed the Chinese version of the Cardiff Wound Impact Schedule, the Hospital Anxiety and Depression Scale, and the Medical Coping Modes Questionnaire after researchers assessed their wound severity. RESULTS The mean scores of physical symptoms and everyday living, social life, and well-being on the Chinese version of the Cardiff Wound Impact Schedule were 55.65 ± 15.82, 52.69 ± 16.46, and 40.75 ± 13.82, respectively. Multiple regression analysis revealed that depression, coping style, and education level were the primary factors, explaining 51.7% of the variance in physical symptoms and everyday living. Depression and coping style explained 49.6% of the variance in social life. Anxiety and primary disease explained 36.2% of the variance in well-being. CONCLUSIONS The factors influencing quality of life for these Chinese patients with chronic wounds included education level, primary disease, anxiety, depression, and coping style. Speaking with patients about living with a chronic wound and their potential for healing, understanding their fears about significant changes to their life, and encouraging them to accept such changes can be important for patients and their recovery.
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Dantas JS, Silva ACDOE, Augusto FDS, Agra G, Oliveira JDS, Ferreira LM, Sawada NO, Freire MEM. HEALTH-RELATED QUALITY OF LIFE IN PEOPLE WITH CHRONIC WOUNDS AND ASSOCIATED FACTORS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0010en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT Objective to assess health-related quality of life in people with chronic wounds and its association with sociodemographic and health characteristics. Method a cross-sectional and analytical study conducted with 85 individuals with chronic wounds in a university hospital from Paraíba, Brazil. The data were collected from June to September 2019 through interviews guided by the Medical Outcome Study 36-item Short-Form Health Survey generic Quality of Life assessment instruments and the Cardiff Wound Impact Schedule specific tool for people with chronic wounds. The Student's t, ANOVA, Mann-Whitney's U, Kruskal-Wallis and Kolmogorov-Smirnov tests were applied to analyze the data, with 5% significance. Results there was predominance of aged and married women with venous wounds not healing for over 24 weeks. The mean score of the generic instrument, which was 35.08, indicated a negative association between the physical capacity domain and female gender; as well as between vitality and age over 60 years old; between emotional aspects and marital status; of functional capacity, limitation of physical activity and emotional aspects with lack of religious practices; and of functional capacity with worse financial situation, all with p≤0.042. The specific instrument had a mean score of 45.57 and presented negative associations in the physical domain with female gender; as well as between social life without religious practices and social life with worse financial situation, all with p≤0.047. Conclusion the scores of the specific and generic instruments indicated low Quality of Life influenced by factors such as female gender, advanced age, being divorced/separated, lack of religious practices and having financial problems.
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Affiliation(s)
| | | | | | - Glenda Agra
- Universidade Federal de Campina Grande, Brasil
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Madsen UR, Hyldig N, Juel K. Outcomes in patients with chronic leg wounds in Denmark: A nationwide register-based cohort study. Int Wound J 2022; 19:156-168. [PMID: 33938122 PMCID: PMC8684858 DOI: 10.1111/iwj.13607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023] Open
Abstract
This study aimed to investigate incidence and predictors of wound healing, relapse, major amputation, and/or death among patients with chronic leg wounds who were referred to specialist treatment at hospital for their condition. A nationwide register-based cohort study design was applied with 5 years of follow-up. All patients with diagnoses of chronic leg wounds in Denmark between 2007 and 2012 were included (n = 8394). Clinical, social, and demographic individual-level linked data from several Danish national registries were retrieved. Incidence rate per 1000 person-years (PY) was calculated. Predictors were investigated using Cox proportional hazards regression analysis. Incidence rates of having a healed wound was 236 per 1000 PY. For relapse, the incidence rate was 75 per 1000 PY, for amputation 16 per 1000 PY, and for death 100 per 1000 PY. Diabetes, peripheral arteria disease, or other comorbidities were associated with decreased chance of wound healing and increased risk of relapse, major amputation, and death. Regional differences in all four outcomes were detected. Basic or vocational education independently predicted risk of amputation and death. This study provides epidemiological data that may help identify patients at particular risk of poor outcomes. It also elucidates social inequality in outcomes.
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Affiliation(s)
- Ulla Riis Madsen
- Department of Orthopedic SurgeryHolbaek HospitalHolbaekDenmark
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative CareUniversity of Southern DenmarkOdenseDenmark
| | - Nana Hyldig
- OPEN, Open Patient data Explorative NetworkOdense University Hospital, Region of Southern DenmarkOdenseDenmark
| | - Knud Juel
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
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Dantas JS, Silva ACDOE, Augusto FDS, Agra G, Oliveira JDS, Ferreira LM, Sawada NO, Freire MEM. QUALIDADE DE VIDA RELACIONADA À SAÚDE DE PESSOAS COM FERIDAS CRÔNICAS E FATORES ASSOCIADOS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0010pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
RESUMO Objetivo avaliar a qualidade de vida relacionada à saúde de pessoas com feridas crônicas e sua associação com características sociodemográficas e de saúde. Método estudo transversal e analítico, realizado com 85 pessoas com feridas crônicas de um hospital universitário da Paraíba - Brasil. Os dados foram coletados de junho a setembro de 2019, por meio de entrevistas, norteadas pelos instrumentos de avaliação da qualidade de vida genérico - Medical Outcome Study 36-item Short-Form Health Survey e específico para pessoas com feridas crônicas - Cardiff Wound Impact Schedule. Para analisar os dados, aplicaram-se os testes t de Student, ANOVA, Teste U de Mann-Whitney, Kruskal-Wallis e Kolmogorov-Smirnov, com significância de 5%. Resultados predominaram mulheres idosas, casadas, com feridas venosas que não cicatrizavam há mais de 24 semanas. O escore médio do instrumento genérico, que foi de 35,08, apontou associação negativa entre o domínio capacidade física e o sexo feminino; vitalidade e idade acima de 60 anos; aspectos emocionais e estado civil; capacidade funcional, limitação de atividade física e aspectos emocionais com falta de práticas religiosas; capacidade funcional com pior situação financeira, todos com p≤0,042. O instrumento específico teve escore médio de 45,57 e apresentou associações negativas no domínio físico com o sexo feminino; vida social sem práticas religiosas e vida social com pior situação financeira, todos com p≤0,047. Conclusão as pontuações dos instrumentos específico e genérico indicaram baixa qualidade de vida influenciadas por fatores como sexo feminino, idade avançada, estar divorciado/separado, falta de práticas religiosas e ter problemas financeiros.
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Affiliation(s)
| | | | | | - Glenda Agra
- Universidade Federal de Campina Grande, Brasil
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Efficacy of a Topical Wound Agent Methanesulfonic Acid and Dimethylsulfoxide on In Vitro Biofilms. Int J Mol Sci 2021; 22:ijms22179471. [PMID: 34502378 PMCID: PMC8431709 DOI: 10.3390/ijms22179471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/20/2022] Open
Abstract
A topical desiccating wound agent containing methanesulfonic acid, dimethylsulfoxide and amorphous silica was evaluated in three in vitro models for its efficacy against biofilms produced by Pseudomonas aeruginosa (ATCC-15442) and Staphylococcus aureus (ATCC-6538). The in vitro biofilm models used were; the MBEC Assay®, Centre for Disease Control (CDC) Biofilm Reactor® and a Semi-solid biofilm model. A 30-s exposure of a topical wound desiccating agent was used in each model. A complete eradication of viable cells was demonstrated in all models for both strains (p < 0.0001). Imaging with scanning electron microscopy (SEM) was performed where possible. All three models demonstrated complete eradication of viable cells with a 30 s application of a topical wound desiccating agent.
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Johnson JB, Broszczak DA, Mani JS, Anesi J, Naiker M. A cut above the rest: oxidative stress in chronic wounds and the potential role of polyphenols as therapeutics. J Pharm Pharmacol 2021; 74:485-502. [PMID: 33822141 DOI: 10.1093/jpp/rgab038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The pathophysiology of chronic wounds typically involves redox imbalance and inflammation pathway dysregulation, often with concomitant microbial infection. Endogenous antioxidants such as glutathione and tocopherols are notably reduced or absent, indicative of significant oxidative imbalance. However, emerging evidence suggests that polyphenols could be effective agents for the amelioration of this condition. This review aims to summarise the current state of knowledge surrounding redox imbalance in the chronic wound environment and the potential use of polyphenols for the treatment of chronic wounds. KEY FINDINGS Polyphenols provide a multi-faceted approach towards the treatment of chronic wounds. Firstly, their antioxidant activity allows direct neutralisation of harmful free radicals and reactive oxygen species, assisting in restoring redox balance. Upregulation of pro-healing and anti-inflammatory gene pathways and enzymes by specific polyphenols further acts to reduce redox imbalance and promote wound healing actions, such as proliferation, extracellular matrix deposition and tissue remodelling. Finally, many polyphenols possess antimicrobial activity, which can be beneficial for preventing or resolving infection of the wound site. SUMMARY Exploration of this diverse group of natural compounds may yield effective and economical options for the prevention or treatment of chronic wounds.
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Affiliation(s)
- Joel B Johnson
- School of Health, Medical and Applied Science, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia.,Centre for Indigenous Health Equity Research, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia
| | - Daniel A Broszczak
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Tissue Repair and Translational Physiology Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Janice S Mani
- School of Health, Medical and Applied Science, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia.,Centre for Indigenous Health Equity Research, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia
| | - Jack Anesi
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, Victoria, Australia
| | - Mani Naiker
- School of Health, Medical and Applied Science, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia.,Centre for Indigenous Health Equity Research, CQUniversity, Bruce Hwy, North Rockhampton, Queensland, Australia
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Zhang F, Chen Z, Su F, Zhang T. Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis. J Wound Care 2021; 30:S28-S36. [PMID: 33856925 DOI: 10.12968/jowc.2021.30.sup4.s28] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing. METHOD A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain. RESULTS From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: -0.81), length of hospital stay (-3.1) and VAS score (-1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine. CONCLUSION This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.
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Affiliation(s)
- Fujie Zhang
- Wound Treatment Center, Tianjin Fifth Central Hospital, Tianjin 300450, P. R. China
| | - Zongnan Chen
- Department of General Surgery, Tianjin Fifth Central Hospital, Tianjin 300450, P. R. China
| | - Feng Su
- Department of General Surgery, Tianjin Fifth Central Hospital, Tianjin 300450, P. R. China
| | - Taijuan Zhang
- Wound Treatment Center, Tianjin Fifth Central Hospital, Tianjin 300450, P. R. China
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30
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Monaro S, Pinkova J, Ko N, Stromsmoe N, Gullick J. Chronic wound care delivery in wound clinics, community nursing and residential aged care settings: A qualitative analysis using Levine's Conservation Model. J Clin Nurs 2021; 30:1295-1311. [PMID: 33506537 DOI: 10.1111/jocn.15674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/21/2020] [Accepted: 12/13/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery. BACKGROUND Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment. DESIGN Descriptive, qualitative study. METHODS Eighteen patients with chronic wounds from three wound services were engaged in semi-structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model. RESULTS Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight. CONCLUSIONS The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital. RELEVANCE TO CLINICAL PRACTICE Shared care between specialist and primary care should include evidence-based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient-held wound plans and upskilling of frontline clinicians.
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Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Sydney, NSW, Australia.,Faculty of Medicine & Health, Susan Wakil School of Nursing & Midwifery, University of Sydney, Camperdown, NSW, Australia
| | - Jana Pinkova
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Natalie Ko
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - Janice Gullick
- Faculty of Medicine & Health, Susan Wakil School of Nursing & Midwifery, University of Sydney, Camperdown, NSW, Australia
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Zhang Y, van Netten JJ, Baba M, Cheng Q, Pacella R, McPhail SM, Cramb S, Lazzarini PA. Diabetes-related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations. J Foot Ankle Res 2021; 14:8. [PMID: 33468226 PMCID: PMC7816323 DOI: 10.1186/s13047-021-00447-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations. Methods We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators. Results Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0–58.8%, of DFD from 1.2–1.5%, and the incidence of diabetes-related amputation ranged from 5.2–7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2–36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3–43.3%, DFD from 7.0–15.1% and amputation during hospitalisation from 1.4–5.8%. Conclusions Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00447-x.
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Affiliation(s)
- Yuqi Zhang
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Jaap J van Netten
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mendel Baba
- Podiatry Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - Qinglu Cheng
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia
| | - Peter A Lazzarini
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, Australia. .,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
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Mitura K. An Innovative National Programme for Comprehensive Chronic Wound Therapy and Its Impact on Treatment Outcomes. World J Surg 2021; 45:1071-1079. [PMID: 33433726 DOI: 10.1007/s00268-020-05901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although the lifetime prevalence of chronic ulcers tends to be approximately 2.2-10 per 1000 population, no systemic solutions for this problem have been implemented in many countries. It is still not fully agreed whether treatment of chronic wounds requires hospitalization, which incurs high costs, or whether the therapy can be carried out entirely in an outpatient setting. Therefore, the aim of this study was to evaluate the 5-year activity and effectiveness of a national programme for the comprehensive treatment of chronic wounds based on hybrid care for patients. Treatment of nonhealing chronic wounds begins in the hospital, where necessary diagnostic actions are carried out, followed by surgical cleansing of the wound and selection of appropriate dressings. Then, the treatment is continued in the outpatient setting with a continuous patient education. The programme is divided into four subsequent stages. In addition, the present study compared the effectiveness of chronic wound treatment with that in the period before implementation of the programme. METHODS From January 2015 to December 2019, 383 patients were treated at a centre for chronic wounds. We analysed the outcomes in 227 individuals with chronic venous ulceration or diabetic foot syndrome. RESULTS The mean wound area at the time of introduction of treatment was 36 cm2 (1-290; SD 34). After three stages of treatment, wounds were completely healed in 139 patients (61.2%), 78 patients with venous ulcers (55.3%) and 61 patients with diabetic foot (70.9%). In an additional 67 cases (29.5%), a significant reduction in wound area and depth was achieved, and the treatment was continued beyond the actual treatment programme. No significant effect was achieved in 21 patients (9.2%). In the group of patients treated without systematic application of the guidelines of the programme, wound healing occurred only in 19 cases (26.8%), reduction in the wound area occurred in 27 patients (38.0%), and lack of any healing progress or even worsening of the wound status was found in the remaining 25 cases (35.2%); these differences were statistically significant (p < 0.001). CONCLUSION Treatment of chronic wounds based on a systematic dedicated programme using an experienced multidisciplinary team of professionals allows to obtain better results in terms of reduction in wound area and might be an effective procedure. The combination of frequent, scheduled outpatient visits, access to inpatient treatment, and regular education of patients based on a standard form improves treatment outcomes.
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Affiliation(s)
- Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland. .,General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland.
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The effects of photobiomodulation on human dermal fibroblasts in vitro: A systematic review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 214:112100. [DOI: 10.1016/j.jphotobiol.2020.112100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/28/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
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Weller CD, Richards C, Turnour L, Team V. Rationale for participation in venous leg ulcer clinical research: Patient interview study. Int Wound J 2020; 17:1624-1633. [PMID: 32658349 PMCID: PMC7948544 DOI: 10.1111/iwj.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022] Open
Abstract
Recruitment to wound care clinical trials is challenging and a better understanding of patient decisions to participate has the potential to influence recruitment success. We conducted 31 semi-structured telephone interviews of patients who participated in the Aspirin in Venous Leg Ulcer (ASPiVLU) randomised controlled trail (RCT) or ASPiVLU cohort study. Data were coded and analysed using thematic analysis. We identified four key themes: (a) "I participated to help others"; (b) "I participated in research to thank those who cared for me"; (c) "I participated to receive better care"; and (d) "I participated to have a say on what works." These themes became basic elements for the Rationale for Research Participation Framework that we have developed to improve the participant recruitment process for clinical trials in wound care.
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Affiliation(s)
| | - Catelyn Richards
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Louise Turnour
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
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35
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Kumar A, Behl T, Chadha S. A rationalized and innovative perspective of nanotechnology and nanobiotechnology in chronic wound management. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Antimicrobial and anti-inflammatory activities of australian native plants in the context of wound healing: A review. Biologia (Bratisl) 2020. [DOI: 10.2478/s11756-020-00636-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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McInnes E, Harvey G, Hiller JE, Phillips R, Page T, Wiechula R. Factors affecting procurement of wound care products: a qualitative study of hospital managers and clinicians. AUST HEALTH REV 2020; 45:66-73. [PMID: 33028462 DOI: 10.1071/ah19250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
Objective To identify factors that influence procurement and disinvestment decisions for wound care products in the acute care setting. Methods A qualitative descriptive study was undertaken. Eighteen face-to-face semi-structured interviews were conducted with purposively sampled senior clinical and non-clinical managers from three Australian acute care hospitals with responsibility for consumables procurement and disinvestment decisions. Data were coded and analysed thematically. Results Three main themes (Systems and triggers, Evidence-free zone, Getting the governance right) with sub-themes were identified that reflect that: (1) procurement processes were often ad hoc and workarounds common. Disinvestment was poorly understood and opportunities were missed to reduce use of low value products ; (2) product selection was commonly based on clinician preference, contractual obligations and information from industry representatives; and (3) improved evidence-based governance and processes are needed to connect procurement and disinvestment decisions and to minimise the influences of clinician preference and industry representatives on product selection. Conclusions Systematic and evidence-based approaches are needed to strengthen procurement and disinvestment decisions related to consumables such as wound care products and to minimise the purchasing of low-value products Decision-making frameworks should consider cost and clinical effectiveness and enable the identification of opportunities to disinvest from low-value products. What is known about the topic? High volume-low unit cost healthcare consumables such as wound care products are a major component of healthcare expenditure. Disinvestment from low-value wound care products has potential to improve patient outcomes and optimise health resources. What does this paper add? Disinvestment was poorly understood and considered in isolation from procurement decisions. Procurement decisions were rarely informed by research evidence, with clinicians exercising considerable freedom to make purchasing decisions based on product preference and industry information. Frameworks and guidelines are needed to guide procurement and disinvestment decision-making for wound care products. What are the implications for practitioners? New models for procurement and disinvestment decision-making for wound care products could help to strengthen decision-making processes, facilitate evidence-based product choices and also prompt consideration of removal of low-value products.
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute - St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Vic 3000, Australia; and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Vic 3000, Australia. ; and Corresponding author.
| | - Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide SA 5005, Australia. ; ;
| | - Janet E Hiller
- Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University of Technology, John Street, Hawthorn, Vic 3122, Australia. ; and School of Public Health, University of Adelaide, 57 North Terrace, Adelaide SA 5005, Australia
| | - Rosemary Phillips
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Vic 3000, Australia.
| | - Tamara Page
- Adelaide Nursing School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide SA 5005, Australia. ; ;
| | - Rick Wiechula
- Adelaide Nursing School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide SA 5005, Australia. ; ;
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Graves N, Maiti R, Aloweni FAB, Yuh AS, Lo ZJ, Harding K. Pressure injuries among admissions to a hospital in the tropics. Int Wound J 2020; 17:1659-1668. [PMID: 32720433 DOI: 10.1111/iwj.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
We report incidence rates for pressure injuries seen in an acute hospital in Singapore that were classified as Stage 3 or Stage 4. The characteristics of patients and the factors that explain variation in the primary outcome of duration of hospital stay are summarized. Existing data were available from Singapore General Hospital for all admissions from January 2016 to December 2019. Univariable analysis was done and a multivariable Poisson regression model estimated. Incidence rates declined from 4.05 to 3.4 per 1000 admissions in the 48 months between 2016 and 2019. The vast majority were community acquired with 75% in admission from the patients' home. Factors that explain variation in length of stay were, ethnicity; site of injury; community versus healthcare associated; inter-hospital transfer; fracture as reason for admission; and the number of days between admission and assessment of wound by specialist nurse. Stage 3 and 4 injuries arise in a home environment most often and are subsequently managed in acute hospital at high cost. These are novel epidemiological data from a hospital in the tropics where the potential to improve outcomes, implement screening and prevention, and thus increase the performance of health services is strong.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore.,Wound Care Innovation for the Tropics Programme, Singapore
| | - Raju Maiti
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | | | - Zhiwen Joseph Lo
- Vascular Surgery Service, Tan Tock Seng Hospital, Singapore.,Nanyang Technological University Lee Kong Chian School of Medicine Centre for Population Health Sciences, Singapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore.,Wound Care Innovation for the Tropics Programme, Singapore
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Dhar A, Needham J, Gibb M, Coyne E. The outcomes and experience of people receiving community-based nurse-led wound care: A systematic review. J Clin Nurs 2020; 29:2820-2833. [PMID: 32279369 DOI: 10.1111/jocn.15278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/13/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To review the literature related to the outcomes and experience of people receiving nurse-led care for chronic wounds in the community. BACKGROUND Chronic wounds lead to a poor quality of life and are an economic burden to the Australian healthcare system. A lack of awareness into the significance of chronic wounds leads to limited resources being available to facilitate the provision of evidence-based care. The majority of chronic wounds are managed by nurses in the community, and a better understanding into current models of care is required to inform future practice. DESIGN A systematic quantitative literature review. METHODS A systematic search was conducted in four electronic databases, and the inclusion criteria were as follows: English language, peer-reviewed, published from 2009-2019 and primary research. The data were compiled into an Excel database for reporting as per the Pickering and Byrne (Higher Education Research & Development, 33, 534.) method of systematic quantitative literature review. This review used the PRISMA checklist. The Mixed Methods Appraisal Tool was used for quality appraisal. RESULTS Twelve studies were included in the review. Home nursing care, social community care and nursing within a wound clinic were identified as three types of nurse-led care in the literature. The findings demonstrate that nurse-led care was cost-effective, reported high levels of client satisfaction and contributed to improved wound healing and reduced levels of pain. CONCLUSIONS Nurse-led care is a positive experience for people with chronic wounds and leads to better outcomes. The findings suggested a need for further client education and specialised training for healthcare practitioners managing chronic wounds. RELEVANCE TO CLINICAL PRACTICE This review demonstrates that nurse-led care for people with chronic wounds in the community is cost-effective and improves client outcomes. Raising awareness into the significance of chronic wounds aims to promote the resources required to facilitate evidence-based care.
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Affiliation(s)
- Anusuya Dhar
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Judith Needham
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Michelle Gibb
- Wound Specialist Services Pty Ltd, Brisbane, QLD, Australia
| | - Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
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Team V, Bouguettaya A, Richards C, Turnour L, Jones A, Teede H, Weller CD. Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis. Int Wound J 2020; 17:370-379. [PMID: 31850664 PMCID: PMC7948898 DOI: 10.1111/iwj.13281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Ayoub Bouguettaya
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Catelyn Richards
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Louise Turnour
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
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41
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Quéré I, Palmier S, Noerregaard S, Pastor J, Sykorova M, Dring E, Franks PJ, Murray S, Keeley V, Bermark S, Karlsmark T, Kyne N, Colgan MP, Coulombe MM, Mestre S, Mercier G, Moffatt CJ. LIMPRINT: Estimation of the Prevalence of Lymphoedema/Chronic Oedema in Acute Hospital in In-Patients. Lymphat Res Biol 2020; 17:135-140. [PMID: 30995191 PMCID: PMC6639107 DOI: 10.1089/lrb.2019.0024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: To estimate the prevalence of lymphedema/chronic edema (CO) and wounds in acute hospital inpatients in five different countries. Methods and Results: A point-prevalence study was carried out during working day periods in six general hospitals in four countries (Denmark, France, United Kingdom, and Australia) and one hospital oncology inpatient unit in one other country (Ireland). The study used validated clinical tools for the assessment and collection of data. Data were collected by expert clinicians through interviews and physical examination of the patients present in the wards. A total of 1905 patients could be included and investigated among the 3041 total bed occupancy in the seven hospitals. Lymphedema/CO was present in 723 of them (38%). Main risk factors associated with CO were age, morbid obesity, and heart failure, as well as chair bound immobility and neurological deficiency. History of cellulitis was frequent in patients with CO and wounds (24.8%) and CO alone (14.1%) compared to the 1.5% prevalence in patients without CO. Conclusion: Lymphedema/CO is very frequent in patients hospitalized in hospital acute wards. It is strongly associated with obesity, venous insufficiency, and heart failure. Our results strongly suggest a hidden health care burden and cost linked to CO independently of chronic wounds.
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Affiliation(s)
- Isabelle Quéré
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Sylvie Palmier
- 2 Department of Dermatology, University Hospital of Montpellier, Montpellier, France
| | - Susan Noerregaard
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jenica Pastor
- 4 Épidémiologiste Unité de Recherche Médico-Economique, DIM, CHU de Montpellier, Montpellier, France
| | - Martina Sykorova
- 5 School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, United Kingdom
| | - Eleanor Dring
- 6 Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
| | - Peter J Franks
- 7 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Susie Murray
- 7 Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Vaughan Keeley
- 8 Lymphoedema Service, Royal Derby Hospital, Derby, United Kingdom
| | - Susan Bermark
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- 3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Norah Kyne
- 9 Department of Physiotherapy, University Hospital Galway, Galway, Ireland
| | - Mary-Paula Colgan
- 10 Department of Vascular and Endovascular Surgery, St. James's Hospital, Dublin, Ireland
| | | | - Sandrine Mestre
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Gregoire Mercier
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Christine J Moffatt
- 1 Department of Vascular Medicine, EA2992, University of Montpellier, CHU Montpellier, Montpellier, France.,3 Copenhagen Wound Healing and Lymphoedema Centre, Bispebjerg University Hospital, Copenhagen, Denmark.,12 School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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42
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Trøstrup H, Holstein P, Karlsmark T, Moser C, Ågren MS. Uncontrolled gelatin degradation in non-healing chronic wounds. J Wound Care 2019; 27:724-734. [PMID: 30398935 DOI: 10.12968/jowc.2018.27.11.724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare matrix metalloproteinase (MMP)-9 and the antiproteinase tissue inhibitor of metalloproteinases (TIMP)-1 in wound fluids and sera from patients with chronic non-healing or acute healing wounds. In addition, the functional consequences on MMP-9 activity and general gelatinase activity were assessed. METHOD In this observational study, samples were collected from patients with venous leg ulcers (VLUs), patients with type 2 diabetes with neuropathic foot ulcers (DFUs), and from another cohort of VLU patients with sterile split-thickness skin graft donor sites after autologous skin grafting, serving as healing control wounds. MMP-9 and TIMP-1 concentrations were determined by enzyme-linked immunosorbent assays. MMP-9 and gelatinase activities were determined in wound fluids in subsets of the patients. RESULTS A total of 24 patients took part in the study. No significant differences in MMP-9 wound fluid levels were found among the three groups. TIMP-1 levels were markedly and significantly lower in the two chronic wound groups resulting in a severely unbalanced MMP-9/TIMP-1 ratio, especially notable in the VLU group and possibly in the elevated endogenous MMP-9 activity (p<0.01) compared with the acute wound fluids. At least 20% of the chronic wound fluids displayed atypical patterns on gelatin zymography and showed high general gelatinase activity that was not inhibited by either TIMP-1 or by a gelatinase inhibitor (AG3340). MMP-9 levels were higher in the sera of the patients with type 2 diabetes. CONCLUSION We hypothesise that non-MMP proteinases contribute to matrix destruction in a significant number of chronic wounds. Blocking the excessive MMP-9 activity may be insufficient to normalise wound healing. The reasons and effects of the very low TIMP-1 levels in chronic wounds need further clarification.
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Affiliation(s)
- Hannah Trøstrup
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Holstein
- Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tonny Karlsmark
- Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Magnus S Ågren
- Professor, Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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43
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Malone M, Schwarzer S, Radzieta M, Jeffries T, Walsh A, Dickson HG, Micali G, Jensen SO. Effect on total microbial load and community composition with two vs six-week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers. Int Wound J 2019; 16:1477-1486. [PMID: 31487117 DOI: 10.1111/iwj.13219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022] Open
Abstract
This study compares two vs six weeks of topical antimicrobial therapy with Cadexomer Iodine in patients with diabetic foot ulcers (DFUs) complicated by chronic biofilm infections. Patients with non-healing DFUs with suspected chronic biofilm infections were eligible for enrolment. Patients were randomised to receive either two or six weeks of treatment with topical Cadexomer Iodine. Tissue biopsies from the ulcers were obtained pre-and-post treatment and underwent DNA sequencing and real-time quantitative polymerase chain reaction (PCR) to determine the total microbial load, community composition, and diversity of bacteria. Scanning electron microscopy confirmed biofilm in all 18 ulcers with suspected chronic biofilm infections. Cadexomer Iodine resulted in 14 of 18 (78%) samples achieving a mean 0.5 log10 reduction in microbial load. Regardless of treatment duration, there was no statistical difference in the reduction of total microbial loads. No difference in the rate of wound healing in the two groups was seen at 6 weeks. Cadexomer Iodine reduces the total microbial load in DFUs with chronic biofilm infections and affects microbial community composition and diversity. All ulcers in both groups showed an initial reduction in wound size with application of Cadexomer Iodine, which might reflect its effect on biofilms.
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Affiliation(s)
- Matthew Malone
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.,High Risk Foot Service, Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia.,Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Saskia Schwarzer
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.,High Risk Foot Service, Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia
| | - Michael Radzieta
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.,Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Thomas Jeffries
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Annie Walsh
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.,High Risk Foot Service, Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia
| | - Hugh G Dickson
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia
| | - Grace Micali
- Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Slade O Jensen
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, New South Wales, Australia.,Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
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44
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McCosker L, Tulleners R, Cheng Q, Rohmer S, Pacella T, Graves N, Pacella R. Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters. Int Wound J 2019; 16:84-95. [PMID: 30259680 PMCID: PMC7948920 DOI: 10.1111/iwj.12996] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic wounds are a significant problem in Australia. The health care-related costs of chronic wounds in Australia are considerable, equivalent to more than AUD $3.5 billion, approximately 2% of national health care expenditure. Chronic wounds can also have a significant negative impact on the health-related quality of life of affected individuals. Studies have demonstrated that evidence-based care for chronic wounds improves clinical outcomes. Decision analytical modelling is important in confirming and applying these findings in the Australian context. Epidemiological and clinical data on chronic wounds are required to populate decision analytical models. Although epidemiological and clinical data on chronic wounds in Australia are available, these data have yet to be systematically summarised. To address these omissions and clarify the state of existing evidence, we conducted a systematic review of the literature on key epidemiological and clinical parameters of chronic wounds in Australia. A total of 90 studies were selected for inclusion. This paper presents a synthesis of the evidence on the prevalence and incidence of chronic wounds in Australia, as well as rates of infection, hospitalisation, amputation, healing, and recurrence.
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Affiliation(s)
- Laura McCosker
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Ruth Tulleners
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Qinglu Cheng
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Stefan Rohmer
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Tamzin Pacella
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
| | - Nick Graves
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Faculty of HealthQueensland University of Technology (QUT)Kelvin GroveQueenslandAustralia
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Berenguer Pérez M, López-Casanova P, Sarabia Lavín R, González de la Torre H, Verdú-Soriano J. Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre-A time series study (2010-2014). Int Wound J 2018; 16:256-265. [PMID: 30393963 DOI: 10.1111/iwj.13026] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023] Open
Abstract
The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010-2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010-2014), with VLUs based on the ICD-10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one-factor analysis of variance (anova) or Kruskal-Wallis non-parametric test, as appropriate. A survival analysis by Kaplan-Meier curves and log-rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal-Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.
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Affiliation(s)
- Miriam Berenguer Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Pablo López-Casanova
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain.,Centro de Salud de Onil, Alicante, Spain
| | | | - Héctor González de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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