Key performance indicators to inform evaluation of wound care programmes for people with complex wounds: a protocol for systematic review

OBJECTIVE

The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken.

METHOD

Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer.

RESULTS

Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search.

CONCLUSION

This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

Semi-analytic solutions of nonlinear multidimensional fractional differential equations

In this paper, the Adomian decomposition method (ADM) and Picard technique are used to solve a class of nonlinear multidimensional fractional differential equations with Caputo-Fabrizio fractional derivative. The main advantage of the Caputo-Fabrizio fractional derivative appears in its non-singular kernel of a convolution type. The sufficient condition that guarantees a unique solution is obtained, the convergence of the series solution is discussed, and the maximum absolute error is estimated. Several numerical problems with an unknown exact solution are solved using the two techniques. A comparative study between the two solutions is presented. A comparative study shows that the time consumed by ADM is much smaller compared with the Picard technique.

Insights on the neuroprotective effects of Salvia officinalis L. and Salvia microphylla Kunth in memory impairment rat model

Salvia species have a traditional longstanding culinary use mostly consumed in the Mediterranean diet as a common spice added to food. Salvia is commonly consumed as an herbal tea for...

Toenail Onychomycosis—A Canadian Approach With a New Transungual Treatment

Background:

Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy.

Objective:

To define a patient-centred Canadian treatment strategy for onychomycosis.

Methods:

An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system.

Results:

First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals.

Conclusion:

These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.

Diabetic foot ulcers: Part I. Pathophysiology and prevention

Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.

Evaluation of a peer-led self-management education programme PEP Talk: Diabetes, Healthy Feet and You

PEP (Peer Education Programme) Talk: Diabetes, Healthy Feet and You is a peer-led self-management programme developed to address the problems of growing prevalence of diabetes and its complications, and limited health care dollars. An evaluation of the programme, how it might be situated within a public health perspective and potential bridges for its implementation in communities throughout Canada and worldwide, are presented. The programme consisted of workshops that were conducted by volunteer peer leaders and health care professionals in 12 communities in 10 Canadian provinces; the volunteers were supported through monthly mentoring teleconferences, on-line tips and discussion board conversations. A web portal was developed to be used by the team, volunteers and community participants. Workshop curriculum was developed based on diabetes footcare and self-management best practise guidelines. Community participants answered pre-and post-workshop statements that indicated that learning occurred, as indicated by an increase in the number of statements answered correctly. Participants' feedback about the workshops was positive. In telephone follow-up interviews, 97% of respondents reported having changed their foot self-management behaviours. The portal was commonly used according to website visits, but not as much as expected for registration of community participants. It is recommended that this programme be made widely available and tailored to the specific needs of the communities and that further evaluation be conducted.

Patient-reported fatigue and overall survival in locally advanced esophageal cancer: A Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry Consortium study

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Background: We examined patient-reported fatigue scores and overall survival (OS) in patients with esophageal cancer (EC) enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry (EABE).

Methods: 1,481 patients enrolled in the EABE between September 2001 and January 2009 returned a baseline quality of life questionnaire including a Linear Analog Self Assessment (LASA) fatigue score which was scored on a 0-10 scale, with 0 as the most extreme fatigue. Patients were categorized as having clinically deficient fatigue (DF) if they reported a score of ≤ 5 and clinically non-deficient fatigue (nDF) if they reported a score of > 5. Kaplan-Meier methodology and Cox models explored OS in relation to fatigue scores in patients with EC.

Results: A total of 667 patients with EC were included in the EABE, of which 659 returned a registry questionnaire with a valid LASA fatigue score recorded. Median age at the time of registry entry was 65 years (range 23-92). A total of 392 (59%) and 267 patients (41%) reported DF and nDF, respectively. On univariate analysis, patients with nDF had improved 5-year survival compared to patients with DF. In patients having esophagectomy prior to LASA, those reporting nDF had improved survival compared to patients with DF. Similarly, in patients having no esophagectomy prior to LASA, those with nDF had improved survival compared to those with DF. Among the 368 patients with locally advanced EC (LAEC), those reporting nDF had improved 5-year overall survival compared to patients with DF (28% vs 17%, HR = 0.67, p = 0.003). This remained significant on multivariate analysis (HR = 0.71, p = 0.015).

Conclusions: Patient-reported fatigue is associated with overall survival in patients with LAEC. As a result, fatigue scores should be considered as a stratification factor in future clinical trial design.

[Table: see text]

No significant financial relationships to disclose.

Synthesis and AT2 receptor-binding properties of angiotensin II analogues

The present study investigates the importance of the amino acid side chains in the octapeptide angiotensin II (Ang II) for binding to the AT2 receptor. A Gly scan was performed where each amino acid in Ang II was substituted one-by-one with glycine. The resulting set of peptides was tested for affinity to the AT2 receptor (porcine myometrial membranes). For a comparison, the peptides were also tested for affinity to the AT1 receptor (rat liver membranes). Only the substitution of Arg2 reduced affinity to the AT2 receptor considerably (92-fold when compared with Ang II). For the other Gly-substituted analogues the affinity to the AT2 receptor was only moderately affected. To further investigate the role of the Arg2 side chain for receptor binding, we synthesized some N-terminally modified Ang II analogues. According to these studies a positive charge in the N-terminal end of angiotensin III [Ang II (2-8)] is not required for high AT2 receptor affinity but seems to be more important in Ang II. With respect to the AT1 receptor, [Gly2]Ang II and [Gly8]Ang II lacked binding affinity (Ki > 10 microM). Replacement of the Val3 or Ile5 residues with Gly produced only a slight decrease in affinity. Interestingly, substitution of Tyr4 or His6, which are known to be very important for AT1 receptor binding, resulted in only 48 and 14 times reduction in affinity, respectively.

[3H]acetylcholine nicotinic recognition sites in human brain: characterization of agonist binding

In the presence of a cholinesterase inhibitor to prevent hydrolysis and atropine to block muscarinic cholinergic receptors, [3H]acetylcholine ([3H]ACh) binding to human brain membranes showed highest levels of nicotinic binding sites in the thalamus. [3H]ACh, in the presence of atropine, binds to heterogeneous high-affinity binding sites in human thalamus. Scatchard analysis of the binding gave a Kd of 0.58 nM and a Bmax of 3.3 pmol/g protein for the 'super high-affinity' site and a Kd of 27 nM and a Bmax of 70 pmol/g protein for the 'high-affinity' site. Moreover, in competition studies nicotinic agonists such (-)-nicotine and carbachol displaceable [3H]ACh-specific binding sites consist of both a high- and a low-affinity population of sites. These results indicate that highest levels of [3H]ACh binding in human brain were found in the thalamus. Moreover, the human thalamus was found to have multiple high-affinity nicotinic agonist sites.

Insulinotrophic drugs. Effect on intestinal abosorption of sugar

The effect of some insulinotrophic drugs on the transport of sugar was investigated in fasted, narcotized rats by continuous perfusion of cannulated long intestinal loops with galactose solution (18 mM.) circulated by air lift. Three consecutive perfusions (fifty minutes each) were performed in each rat, the drug being given in the second perfusion only. The rate of galactose disappearance was expressed as per cent of that in the first perfusion in the same rat.

Tolbutamide (50 mg./l kg. weight), glycodiazine (50 mg./l kg. weight), glisoxepid (BAY 4231, 2 mg./l kg. weight) and glibenclamide (0.25 mg./l kg. weight) were found to increase the rate of galactose disappearance in the second perfusion by 21 per cent, 5 per cent, 12 per cent and 25 per cent, respectively, and in the third perfusion by 21 per cent, 26 per cent, 32 per cent and 21 per cent, respectively, as compared to the rate in the corresponding perfusion of a control group. This increase was significant (P values &lt; 0.05) with all drugs in the second and third perfusions with the exception of glisoxepid in the second perfusion. These results are discussed in relation to the action of insulin and the effect of diabetes on intestinal absorption of sugars.