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Tam SH, Lai WS, Kao CY, Fang SY. "Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan. J Pain Symptom Manage 2024; 68:69-77.e1. [PMID: 38621610 DOI: 10.1016/j.jpainsymman.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
CONTEXT Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. OBJECTIVES To explore the experiences in caring for patients with MFWs among nurses in Taiwan. METHODS Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. RESULTS Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. CONCLUSION The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.
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Affiliation(s)
- Sin Hang Tam
- Medical Oncology and Palliative Care (S.H.T.), St George's University Hospitals NHS Foundation Trust, London, UK
| | - Wei-Sue Lai
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Su-Ying Fang
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan; Department of Nursing (S.Y.F.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Pramod S, Dumville J, Norman G, Stringer J. A survey of UK nurses about their care of people with malignant fungating wounds. Eur J Oncol Nurs 2024; 70:102609. [PMID: 38810584 DOI: 10.1016/j.ejon.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care. METHOD An online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS. RESULT We received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators. CONCLUSION This is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.
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Affiliation(s)
- Susy Pramod
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - Jo Dumville
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; Division of Nursing, Midwifery & Social Work, School of Health Science, Faculty of Biology, Medicine &Health, University of Manchester, UK
| | - Gill Norman
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, UK; Division of Nursing, Midwifery & Social Work, School of Health Science, Faculty of Biology, Medicine &Health, University of Manchester, UK
| | - Jacqui Stringer
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
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Liu X, Xie JQ, Liao ZY, Wei MJ, Lin H. Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds. J Wound Care 2024; 33:262-270. [PMID: 38573899 DOI: 10.12968/jowc.2024.33.4.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL. METHOD This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models. RESULTS A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds. CONCLUSION The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.
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Affiliation(s)
- Xin Liu
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Jin-Qin Xie
- Nursing department, Guangxi Medical University Affiliated Cancer Hospital, NanNing 530021, China
| | - Zhao-Yu Liao
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Mei-Juan Wei
- Department of Oncology, Affiliated Hospital of Youjiang Medical College for Nationalities, BaiSe 533099, China
| | - Hua Lin
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
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Cornish L. Managing malignant wounds in patients receiving palliative care. Nurs Stand 2023; 38:59-66. [PMID: 36530148 DOI: 10.7748/ns.2022.e12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 06/17/2023]
Abstract
Malignant wounds are a complication of cancer and usually develop in patients with advanced disease. Physical symptoms associated with these wounds include pain, bleeding, exudate, malodour and pruritus, while patients may also experience various distressing psychosocial effects. The aim for nurses is to manage these physical symptoms and psychosocial effects, thus enhancing quality of life for patients and their families. This article discusses the symptoms and effects associated with malignant wounds, and explains what is involved in a wound assessment. It also outlines strategies that can be used to manage or eliminate wound-related symptoms and enhance patients' quality of life.
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Fungating Malignancies: Management of a Distinct Wound Entity. Adv Skin Wound Care 2022; 35:646-652. [PMID: 36409187 DOI: 10.1097/01.asw.0000891852.64709.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
GENERAL PURPOSE To provide information on the surgical management of fungating malignancies as a distinct wound entity. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify characteristics of patients in a study examining the treatment of fungating malignancies.2. Select common symptoms experienced by patients with fungating malignancies.3. Explain issues related to the surgical treatment of fungating malignancies.4. Identify a reason why patients with fungating breast masses may avoid medical care.
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Furka A, Simkó C, Kostyál L, Szabó I, Valikovics A, Fekete G, Tornyi I, Oross E, Révész J. Treatment Algorithm for Cancerous Wounds: A Systematic Review. Cancers (Basel) 2022; 14:cancers14051203. [PMID: 35267512 PMCID: PMC8909326 DOI: 10.3390/cancers14051203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment strategy, symptoms progress, and adversely influence quality of life. METHODS Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information. RESULTS Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases. CONCLUSIONS This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.
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Affiliation(s)
- Andrea Furka
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Correspondence: ; Tel.: +36-309988499
| | - Csaba Simkó
- Erzsébet Hospice, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary;
| | - László Kostyál
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Department of Diagnostic Imaging, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary
| | - Imre Szabó
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Anikó Valikovics
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Gábor Fekete
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Ilona Tornyi
- Department of Human Genetics, University of Debrecen, 4032 Debrecen, Hungary;
- Biosystems Immunolab Zrt., 4032 Debrecen, Hungary
| | - Endre Oross
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - János Révész
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
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Uebach B, Krull E, Simon ST, Bausewein C, Voltz R, Doll A. [Guideline-based Care for patients with malignant lesions : The new S3 guideline for patients with incurable cancer]. HNO 2022; 70:167-178. [PMID: 35171305 DOI: 10.1007/s00106-022-01145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is a lack of evidence-based guidelines about fungating wounds and a confusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patients with malignant wounds and stabilize or improve their quality of life. The guideline is constructed following the German Instrument for Methodological Guideline Appraisal (DELBI): A systematic review was carried out for guidelines and reviews. A wound expert group discussed these research findings and suggested recommendations which were adapted and consented by representatives of 62 medical and health professionals associations.The guideline has 34 recommendations, thereof nine (26%) are evidence based with an evidence level from 2+ to 4 (according to SIGN). The assessment chapter comprises specific assessment tools for malignant wounds, odor and wound-related quality of life. Three recommendations address the psychosocial support of patients and their family caregivers and aim to reduce the impact of the wound on their emotional wellbeing, caregiver burden and social participation. The pain recommendations focus on a preventive atraumatic dressing change, positioning, systemic pain medication (anticipated, rescue and baseline) and local application of morphine or local anesthetics. The guideline gives recommendations on odor management (metronidazole, active coal and antiseptic dressings) and management of exudate (super absorber). The recommendations on prevention and management of bleeding (antifibrinolytica, haemostyptica) are vital for patients and caregivers. This guideline is one of the first evidence-based and consented guideline on malignant wound care and has the potential to improve the palliation of patients who suffer from there malignant wounds.
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Affiliation(s)
- Barbara Uebach
- Zentrum für Palliativmedizin, Helios Klinikum Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, 53123, Bonn, Deutschland.
| | - Elisabeth Krull
- Zentrum für Ambulante Hospiz- und Palliativversorgung München Land und Stadtrand Caritas-Zentrum Taufkirchen, Deutschland, Oberhaching
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | | | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Axel Doll
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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Luo B, Xiao Y, Jiang M, Wang L, Ge Y, Zheng M. Successful Management of Exudate and Odor Using a Pouch System in a Patient with Malignant Facial Wound: A Case Report. Asia Pac J Oncol Nurs 2022; 9:236-241. [PMID: 35571624 PMCID: PMC9096734 DOI: 10.1016/j.apjon.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant fungating wounds are associated with heavy exudate and malodor, and can thus have a devastating impact on the physical, psychological, and functional health of patients at the end of life. Management is typically limited to the use of more absorbent dressings and frequent changing of dressings. However, this method is associated with a large amount of time needed for wound care, and does not always resolve the problem of malodor. Herein, we report the use of an inexpensive ostomy pouch to manage facial fungating wounds caused by maxillary gingival carcinoma. The pouches are adhered to the skin, and collect a large amount of malodorous exudate for days without leaking. Fewer dressing changes and the absence of malodor result in an improved quality of life for the patient and family.
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Ferreira SADC, González CVS, Faresin AADC, Thum M, Rosa TDS, Woo K, Santos VLCDG. Terapia tópica para el tratamiento del dolor en heridas neoplásicas malignas: protocolo de revisión de alcance. J Wound Care 2021; 30:11-17. [PMID: 34558973 DOI: 10.12968/jowc.2021.30.latam_sup_1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A total of 14.5% of cancer patients develop malignant neoplastic wounds (MNW), characterised as friable, exudative, fetid, bleeding, and painful. Some studies report that all patients with MNW experience pain, but there is lack of scientific evidence to support their treatment. OBJECTIVE To map and examine the existing evidence on topical therapies to manage pain in adult patients with MNW. METHOD A scoping review protocol was designed, according to the Joanna Briggs Institute (JBI) methodology. The databases CINAHL, LILACS, Embase, Scopus, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and the grey literature, for searching published and unpublished studies in English, Portuguese and Spanish. The selection will be made by at least two reviewers. The summary of the results will be narrative, with graphs and tables. Qualitative and quantitative studies and reviews will be included, describing the use of topical pain therapies in patients with MNW. CONCLUSION This study will allow to classify and discuss the available topical therapies, and to recommend future primary studies.
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Affiliation(s)
- Suzana Aparecida da Costa Ferreira
- Programa de Posgrado de Enfermería en la Salud del Adulto (PROESA), Universidade de São Paulo, Escola de Enfermagem-EEUSP, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado de Enfermería en la Salud del Adulto (PROESA), Universidade de São Paulo, Escola de Enfermagem-EEUSP, San Pablo, Brasil
| | - Adriane Aparecida da Costa Faresin
- Instituto de Cáncer del Estado de São Paulo (ICESP) del Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), San Pablo, Brasil
| | - Magali Thum
- Programa de Posgrado de Enfermería en la Salud del Adulto (PROESA), Universidade de São Paulo, Escola de Enfermagem-EEUSP, San Pablo, Brasil
| | - Talita Dos Santos Rosa
- Programa de Posgrado de Enfermería en la Salud del Adulto (PROESA), Universidade de São Paulo, Escola de Enfermagem-EEUSP, San Pablo, Brasil
| | - Kevin Woo
- Escuela de Enfermería, Queen's University, Kingston, Ontario, Canadá
| | - Vera L C de Gouveia Santos
- Universidade de São Paulo, Escola de Enfermagem-EEUSP, Departamento de Enfermería Médico-Quirúrgica, San Pablo, Brasil
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Jones J, Hampton S. Use of a superabsorbent dressing in the management of exudate in hard-to-heal wounds. Br J Community Nurs 2021; 26:S20-S29. [PMID: 33688756 DOI: 10.12968/bjcn.2021.26.sup3.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With the shift in demographics towards an ageing population with multimorbidity, the number of hard-to-heal (chronic) wounds is increasing each year. This poses a challenge for both health professionals, for whom wound management is becoming more complex, and for patients, who have to cope with exudate production, malodour and pain. This article summarises understanding of healing in such wounds and how best to meet the challenge of exudate, which is a ubiquitous hallmark of hard-to-heal wounds. The role of superabsorbent dressings is considered, with particular reference to Kliniderm superabsorbent in the management of people with these challenging wounds.
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Affiliation(s)
| | - Sylvie Hampton
- Tissue Viability Consultant Nurse, Director of Wound Care Consultancy Ltd. (this author contributed all the case studies)
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Firmino F, Santos J, Meira KC, de Araújo JL, Júnior VA, de Gouveia Santos VLC. Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol. J Wound Care 2020; 29:52-60. [PMID: 31930944 DOI: 10.12968/jowc.2020.29.1.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.
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Affiliation(s)
- Flávia Firmino
- School of Nursing of the University São Paulo, São Paulo, Brazil.,National Cancer Institute José Alencar Gomes da Silva. Palliative Care Unit - Hospital of Cancer IV/HC IV, Rio de Janeiro, Brazil
| | - Juliano Santos
- School of Nursing of the University São Paulo, São Paulo, Brazil.,National Cancer Institute José Alencar Gomes da Silva. Palliative Care Unit - Hospital of Cancer IV/HC IV, Rio de Janeiro, Brazil
| | - Karina Cardoso Meira
- School of Health of the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | | | - Valter Alvarenga Júnior
- Post-Graduate Program in Surgical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,National Cancer Institute José Alencar Gomes da Silva, Hospital of Cancer III, Unit of Treatment and Control of Breast Cancer, Rio de Janeiro, Brazil
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Virgen CA, Barker CA, Lacouture ME. The microbial flora of clinically infected cutaneous metastases: a retrospective study. Clin Exp Dermatol 2020; 45:722-726. [PMID: 32304588 DOI: 10.1111/ced.14241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 01/20/2023]
Abstract
Symptomatic cutaneous metastases are associated with discharge, malodour, pruritus and pain, all of which may negatively impact quality of life and cutaneous health. We conducted a retrospective chart review of patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015, and characterized the microbial flora and antimicrobial management of cutaneous metastases in 64 patients. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our findings suggest that the normal skin microbial flora is disrupted in patients with symptomatic skin metastases. Oral antibiotics may provide benefit when used as first-line therapy for infected skin lesions in patients with symptomatic cutaneous metastases.
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Affiliation(s)
- C A Virgen
- Department of Dermatology, University of California Irvine, Irvine, USA
| | - C A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Akhmetova A, Lanno GM, Kogermann K, Malmsten M, Rades T, Heinz A. Highly Elastic and Water Stable Zein Microfibers as a Potential Drug Delivery System for Wound Healing. Pharmaceutics 2020; 12:E458. [PMID: 32443445 PMCID: PMC7284525 DOI: 10.3390/pharmaceutics12050458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
The development of biomaterials for wound healing applications requires providing a number of properties, such as antimicrobial action, facilitation of cell proliferation, biocompatibility and biodegradability. The aim of the present study was to investigate morphological and mechanical properties of zein-based microfibers, ultimately aimed at creating an environment suitable for wound healing. This was achieved through co-axial electrospinning of core-shell microfibers, with zein protein in the core and polyethylene oxide (PEO) in the shell. Small amounts of PEO or stearic acid were additionally incorporated into the fiber core to modify the morphology and mechanical properties of zein fibers. The presence of PEO in the core was found to be essential for the formation of tubular fibers, whereas PEO in the shell enhanced the stability of the microfibers in water and ensured high elasticity of the microfiber mats. Tetracycline hydrochloride was present in an amorphous form within the fibers, and displayed a burst release as a result of pore-formation in the fibers. The developed systems exhibited antimicrobial activity against Staphylococcus aureus and Escherichia coli, and showed no cytotoxic effect on fibroblasts. Biocompatibility, antimicrobial activity and favorable morphological and mechanical properties make the developed zein-based microfibers a potential biomaterial for wound healing purposes.
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Affiliation(s)
- Alma Akhmetova
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark; (A.A.); (M.M.); (T.R.)
| | | | - Karin Kogermann
- Institute of Pharmacy, University of Tartu, 50411 Tartu, Estonia;
| | - Martin Malmsten
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark; (A.A.); (M.M.); (T.R.)
- Department of Physical Chemistry, Lund University, 221 00 Lund, Sweden
| | - Thomas Rades
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark; (A.A.); (M.M.); (T.R.)
| | - Andrea Heinz
- LEO Foundation Center for Cutaneous Drug Delivery, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark; (A.A.); (M.M.); (T.R.)
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Schmidt FMQ, Firmino F, Lenza NDFB, Santos VLCDG. Nursing team knowledge on care for patients with fungating wounds. Rev Bras Enferm 2020; 73:e20170738. [DOI: 10.1590/0034-7167-2017-0738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher’s exact test, Student’s t-Test and Pearson’s correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.
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Hypofractionated radiation therapy for durable palliative treatment of bleeding, fungating breast cancers. Pract Radiat Oncol 2019; 9:73-76. [DOI: 10.1016/j.prro.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/21/2022]
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Žulec M, Rotar-Pavlič D, Puharić Z, Žulec A. "Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E559. [PMID: 30769943 PMCID: PMC6406886 DOI: 10.3390/ijerph16040559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.
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Affiliation(s)
- Mirna Žulec
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Danica Rotar-Pavlič
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana 1000, Slovenia.
| | - Zrinka Puharić
- Study of Nursing, Bjelovar University of Applied Sciences, Trg. E.Kvaternika 4, Bjelovar 43000, Croatia.
| | - Ana Žulec
- Polyclinic Marija, Kneza Mislava 2, Zagreb 10000, Croatia.
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Darwin E, Tomic-Canic M. Healing Chronic Wounds: Current Challenges and Potential Solutions. CURRENT DERMATOLOGY REPORTS 2018; 7:296-302. [PMID: 31223516 PMCID: PMC6585977 DOI: 10.1007/s13671-018-0239-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to raise awareness, examine the challenges faced by wound care researchers and explore opportunities for potential improvements. RECENT FINDINGS Chronic wounds are associated with significant morbidity and mortality, and they represent a major medical and financial burden. Despite this, no new therapy has received FDA efficacy approval for the treatment of chronic wounds since 1997. Previous preclinical studies using animal models did not translate to human wounds due to inherent limitations of experimental models, variability in assessment methods and overall experimental design. Clinical trials continued to be challenged by the balance of the inclusion and exclusion criteria, the high cost and time expenditure of the trials, and the constraint of a single FDA-acceptable outcome of complete wound closure. SUMMARY Wound research faces multiple challenges in both pre-clinical and clinical research that slowed progress and development of efficacious therapies. Solutions to such challenges will provide new opportunities for improved study design in the future.
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Affiliation(s)
- Evan Darwin
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 2023, Miami, FL, 33136, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 2023, Miami, FL, 33136, USA
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Woo K, Hill R, LeBlanc K, Percival SL, Schultz G, Weir D, Swanson T, Mayer DO. Effect of a surfactant-based gel on patient quality of life. J Wound Care 2018; 27:664-678. [DOI: 10.12968/jowc.2018.27.10.664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Woo
- Associate Professor, Queen's University, Kingston, Canada
| | - Rosemary Hill
- Wound Ostomy Continence Clinician, Vancouver Coastal, Canada
| | | | - Steven L. Percival
- CEO and Director, Centre of Excellence in Biofilm Science and Technologies, Liverpool, UK
| | - Gregory Schultz
- Researcher, Professor Ob/Gyn, Director Institute for Wound Research University of Florida, Gainesville, Florida, US
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | | | - Dieter O. Mayer
- Head of Vascular Surgery Unit and Wound Centre, Department of Surgery, HFR Fribourg — Cantonal Hospital, Fribourg, Switzerland
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Seckam AM, Mercer J. Older patients' experiences and perceptions of having their wounds treated with medical-grade honey. ACTA ACUST UNITED AC 2018; 27:S22-S29. [PMID: 30089055 DOI: 10.12968/bjon.2018.27.15.s22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ancient remedies in wound care have been used for millennia and are now being rediscovered; in particular, the use of honey. The purpose of this study was to capture and explore the meanings that participants assign to their lived experiences when using medical-grade honey to treat wounds. Six participants were recruited from a Lindsey Leg Club support group. Semi-structured interviews were conducted and the verbatim transcriptions were analysed using interpretative phenomenological analysis. Two themes were identified: experiences of using medical-grade honey and perceptions of honey as a natural folkloric medicine. This study revealed the complexity of using medical-grade honey to treat wounds and highlights patients' experiences and perceptions. The findings are reviewed and discussed in relation to the literature and implications for further research and clinical practice are suggested.
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Affiliation(s)
- Abdul M Seckam
- Stroke Research and Innovation Manager, Cardiff Metropolitan University
| | - Jenny Mercer
- Reader in Qualitative Approaches to Applied Psychology, Principal Lecturer and Graduate Studies Co-ordinator, Cardiff Metropolitan University
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Darwin ES, Thaler ER, Lev-Tov HA. Wound odor: current methods of treatment and need for objective measures. GIORN ITAL DERMAT V 2018; 154:127-136. [PMID: 30014682 DOI: 10.23736/s0392-0488.18.05960-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic wounds are an enormous burden to society, costing billions of dollars annually in the USA alone. Despite the extensive research into methods to heal chronic wounds, many remain unhealed for months to years. There is a need to focus on patient reported outcomes to improve quality of life in patients with non-healing wounds. Wound odor has a significant impact on patient quality of life; however, relatively little information is available on the management of wound odor. We review the current data available on wound odor and discuss the need for standardized objective measures of odor to improve research quality. An independent search of the PubMed and Embase databases was conducted using combinations of the following words or phrases: "wounds," "chronic wounds," "diabetic ulcers," "venous leg ulcers (VLUs)," "malignant ulcers," "odor," "odour," "smell," "malodor," "artificial olfaction," "electronic nose," and "e-nose." Article references were also searched for significance. There are few overall studies on wound odor, and fewer randomized controlled trials. Current trials on odor have consistent weaknesses such as subjective measures and poor methodology. No single odor treatment modality has been demonstrated to be widely effective for wound odor or superior to other methods. Future research should incorporate objective measures of odor such as electronic noses into clinical trials.
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Affiliation(s)
- Evan S Darwin
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA -
| | - Erica R Thaler
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hadar A Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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Freitas de Castro MC, Santos WAD, Fuly PDSC, Caldeira dos Santos MLS, Ribeiro Garcia T. Intervenções de enfermagem para pacientes oncológicos com odor fétido em ferida tumoral. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).
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Tamai N, Mugita Y, Ikeda M, Sanada H. The relationship between malignant wound status and pain in breast cancer patients. Eur J Oncol Nurs 2016; 24:8-12. [PMID: 27697281 DOI: 10.1016/j.ejon.2016.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Skin metastasis is one of the most frequent metastases in breast cancer patients. Patients with malignant wounds experience numerous symptoms, including serious wound pain. However, the features of pain related to malignant wounds have not been investigated. Nurses can experience a dilemma when treating these patients due to a lack of knowledge of the pain. The aims of this study were to examine the quality and intensity of malignant wound pain and to determine the association between wound status and pain in the patients with malignant wounds. METHODS Cross-sectional study was conducted. Participants were recruited from a breast centre based in a general hospital. We collected the patients' demographic and wound management data and assessed wound condition. Patients evaluated wound pain intensity and quality over the preceding week using the short-form McGill Pain Questionnaire (SF-MPQ). The association between SF-MPQ results, wound condition, and the time interval for wound care was evaluated using the Spearman's correlation coefficient. The protocol was approved by the Ethical Committee of the each facilities. RESULTS The median age of the 22 enrolled patients was 61.5 years, and the median time after diagnosis of malignant wound was 15.5 months. Overall, 77.3% of patients complained of pain. Malignant wound pain significantly correlated with the degradation of wound edges, granulation tissue, and the time interval for wound care. CONCLUSION We consider that it is necessary to provide pain-control care focused on the wound edge and granulation tissue of malignant wounds through the assessment of malignant wound pain and condition.
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Affiliation(s)
- Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mari Ikeda
- Department of Nursing Administration and Advanced Clinical Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 113-0033, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Abstract
BACKGROUND Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision, but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through selection of appropriate dressings and topical agents. OBJECTIVES To review the evidence of the effects of dressings and topical agents on quality of life, and symptoms that impact on quality of life, in people with fungating malignant wounds. SEARCH METHODS For this third update we searched the Wounds Group Specialised Register in August 2013; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. SELECTION CRITERIA Eligible studies comprised randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group. DATA COLLECTION AND ANALYSIS Data extraction and risk of bias assessment was undertaken by one review author and checked for accuracy by a second. MAIN RESULTS Four trials involving 164 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. The study reported that the time to treatment failure was significantly longer in the miltefosine group (median 56 days) than in the placebo group (median 21 days) (p value 0.007, log-rank test). A second trial compared topical metronidazole with placebo but the results up to the point of cross-over were not statistically significant. A third trial compared the effect of foam dressings containing silver to foam dressings without silver and found that more patients experienced decreased malodour in the foam with silver group than in the foam alone group (p value=0.049). The fourth trial compared the effect of manuka honey-coated dressings with nanocrystalline silver-coated dressings and found no statistically significant difference with regard to exudate, malodour and wound pain. All trials, however, had methodological limitations. AUTHORS' CONCLUSIONS There is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer, may slow disease progression. There is also weak evidence to suggest that foam dressings containing silver may be effective in reducing malodour. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed.
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Affiliation(s)
- Una J Adderley
- University of LeedsSchool of HealthcareRoom 2.22Baines WingLeedsUKLS2 9JT
| | - Ian GS Holt
- University of LeedsSchool of HealthcareRoom 2.22Baines WingLeedsUKLS2 9JT
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