Defining wound bed conformability: a new testing methodology to assess the relative swelling rise of foam dressings

OBJECTIVE

Using a dressing that expands and conforms to the wound bed upon exudate absorption is one of the best ways to promote wound healing. While many products claim wound bed conformability, no externally replicated or verified test methodology had been developed to quantify a wound dressing's ability to conform to the wound bed. The Relative Swelling Rise (RSR) test methodology was developed to measure the relative swelling rise of foam dressings upon fluid absorption, and offers a quantifiable and easily replicated method to measure wound bed conformability.

METHOD

The RSR test method was developed, validated and reliability tested by Coloplast A/S, Denmark. External replication was provided by ALS Odense, Denmark (previously DB Lab). Circular fences provide a fixed diameter to apply and contain the fluid and prevent horizontal spreading in the test set-up. The swelling height is quantified relative to the fence's inner diameter, i.e., the ratio alpha (α), and allows evaluation of a material's ability to conform to the wound bed.

RESULTS

Biatain Silicone foam products (n=3, Coloplast A/S, Denmark) were tested, all afforded an average α-ratio from 0.30 to 0.60. The relative standard deviations were between 1-3%, demonstrating the strength of the test. Robustness of the methodology was demonstrated through the internal validation study, the reliability study, and both an internal and external replication study, as well as a systematic literature review and expert review of the construct, content, criterion and generalisability of the method.

CONCLUSION

Having a validated, effective and easily replicable testing method to quantify wound bed conformability of foam dressings is an important step towards achieving better healing outcomes.

Prelude to Death or Practice Failure? Trombley-Brennan Terminal Tissue Injury Update

In 2012, we published a study in this journal exploring the emergence of unique skin changes in end-of-life patients admitted to a palliative care unit. The purpose of the study was to describe the skin changes and identify the relationship between these changes and time of death. In the above study of 80 patients, the skin changes were found to be unique and different from Kennedy terminal ulcers and deep tissue injuries. Median time from identification of skin changes and death was 36 hours. The phenomenon was named as Trombley-Brennan terminal tissue injury. The current article presents findings that include the study of additional 86 patients. The results further validate the phenomenon and its relationship with time of death.

Prelude to Death or Practice Failure? Trombley-Brennan Terminal Tissue Injuries

A group of palliative care nurses wanted to investigate the phenomenon they were witnessing in their end-of-life patients. There was a rapid onset of skin change characterized by bruising on various parts of the body in these patients. Traditionally they were described as pressure ulcers. However, the skin changes did not progress as typical pressure ulcers and warranted more investigation.

Stylopeptide 2, a proline-rich cyclodecapeptide from the sponge Stylotella sp

A new proline-rich cyclodecapeptide, designated stylopeptide 2, has been isolated from a cytotoxic extract of the Papua New Guinea marine sponge Stylotella sp. and found to correspond to structure 1. The structural assignment was based on HRMS collision-induced dissociation tandem mass spectrometry (CID MS/MS), NMR spectroscopic data, and amino acid analysis, which led to assignment of the absolute configuration.

Subdural empyema

Despite the availability of new broad-spectrum antibiotics, sinusitis occasionally causes significant morbidity and mortality. One serious complication of paranasal sinusitis is subdural empyema, a fulminating intracranial disease that is invariably fatal if not treated. The symptoms of subdural empyema may be mild and may be the same as those associated with sinusitis, or the infection may result in alteration of the level of consciousness and focal neurologic deficits. Rapid recognition and treatment of subdural empyema is extremely important. Before magnetic resonance imaging became available, computed tomography was used for rapid diagnosis of this infection. Magnetic resonance imaging, however, is now becoming the diagnostic tool of choice. Neurosurgical intervention and high doses of intravenously administered antibiotics are the mainstays of treatment. If treatment is initiated as soon as the diagnosis of subdural empyema is made, the patient has a good chance of recovering with no, or only slight, neurologic defects.

Kahukuenes, new diterpenoids from the marine alga Laurencia majuscula

Kahukuenes A [4] and B [5], new diterpenoids possessing an unprecedented prenylated chamigrene structure as part of a decalin ring, were isolated from the Hawaiian marine alga Laurencia majuscula. Spectroscopic methods, including extensive 1D and 2D nmr studies, were used to establish the structure and relative stereochemistry of these two secondary metabolites.