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Fatty acid potassium improves human dermal fibroblast viability and cytotoxicity, accelerating human epidermal keratinocyte wound healing in vitro and in human chronic wounds

Abstract

Effective cleaning of a wound promotes wound healing and favours wound care as it can prevent and control biofilms. The presence of biofilm is associated with prolonged wound healing, increased wound propensity to infection, and delayed wound closure. Anionic potassium salts of fatty acids are tested with commonly used anionic surfactants, such as sodium laureth sulphate (SLES) and sodium lauryl sulphate/sodium dodecyl sulphate (SLS/SDS). The normal human dermal cells demonstrated significantly greater viability in fatty acid potassium, including caprylic acid (C8), capric acid (C10), lauric acid (C12), oleic acid (C18:1), and linoleic acid (C18:2), than in SLES or SLS after a 24‐hour incubation. Cytotoxicity by LDH assay in a 5‐minute culture in fatty acid potassium was significantly lower than in SLES or SLS. in vitro wound healing of human epidermal keratinocytes during the scratch assay in 24‐hour culture was more significantly improved by fatty acid treatment than by SLES or SLS/SDS. In a live/dead assay of human epidermal keratinocytes, C8K and C18:1K demonstrated only green fluorescence, indicating live cells, whereas synthetic surfactants, SLES and SLS, demonstrated red fluorescence on staining with propidium iodide, indicating dead cells after SLES and SLS/SDS treatment. Potassium salts of fatty acids are useful wound cleaning detergents that do not interfere with wound healing, as observed in the scratch assay using human epidermal keratinocytes. As potassium salts of fatty acids are major components of natural soap, which are produced by natural oil and caustic potash using a saponification method, this may be clinically important in wound and peri‐wound skin cleaning. In human chronic wounds, natural soap containing fatty acid potassium increased tissue blood flow based on laser speckle flowgraphs after 2 weeks (P < .05), in addition to removing the eschars and debris. Wound cleansing by natural soap of fatty acid potassium is beneficial for wound healing.

Association of wound genesis on varying aspects of health‐related quality of life in patients with different types of chronic wounds: Results of a cross‐sectional multicentre study

Abstract

Patients with chronic wounds are significantly impaired in their health‐related quality of life (HRQoL). The validated Wound‐QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life‐related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross‐sectional, multicentre study, Wound‐QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life‐related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound‐QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient‐oriented treatments, the Wound‐QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health‐related quality of life. Validated Wound‐QoL questionnaire is a quick and easy‐to‐use instrument for daily practice. Wound‐related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound‐related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health‐related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.

Onion extract gel is not better than other topical treatments in scar management: A meta‐analysis from randomised controlled trails

Abstract

To evaluate the efficacy and safety of onion extract (OE) gel on scar management, a systematic review was performed by searching Embase, PubMed, Medline, and the Cochrane Library databases, and a meta‐analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement guidelines. Finally, 13 randomised controlled trails were enrolled for meta‐analysis. OE gel increased the total improvement scores assessed by investigators (P < .00001) and patients (P < .00001) than no treatment, but no differences were detected between OE gel and other commonly used topical treatments assessed by investigators (P = .56) and patients (P = .39). Moreover, OE in silicone gel increased the total improvement scores assessed by investigators (P < .00001) and patients (P = .0007) than other treatments. OE gel increased the incidence of total adverse effects compared with no treatment (P < .0001) and other treatments (P = .008) by a fixed‐effects model, and increased the incidence of dropping out caused by intolerance of treatments (P = .0002). OE gel not only has no superiority to commonly used topical treatments, but also has the potential to increase the incidence of adverse effects on scar management; OE in silicone gel might be the optimal topical choice for scar treatment; however, more evidences are needed to strength these conclusions.

The effects of lockdown measures due to COVID‐19 pandemic on burn cases

Abstract

In this study, it was aimed to investigate the effects of lockdown measures implemented due to COVID‐19 on aetiology, sociodemographic characteristics, and clinical status of burn cases. This study was carried out retrospectively at the Burn Unit of Dicle University Medical Faculty Hospital. The burn cases during the COVID‐19 outbreak were compared with those of the previous 2 years. Statistical analyses were carried out using the IBM SPSS (Statistics Package for Social Sciences) Statistics 25. Descriptive statistics, independent samples t‐test, Kolmogorov‐Smirnov test, and Shapiro‐Wilk test were used for data evaluation. Results were evaluated at 95% confidence interval and P < .05 significance level. It was determined that burn cases were reduced by half during the COVID‐19 compared to the previous 2 years. Despite the increase in the number of third‐degree burns and surgeries, it was determined that the length of hospital stay decreased by an average of two thirds. Hot liquids have been identified as the most important cause of burns in all years. New studies should be conducted in order to examine the social dimension of COVID‐19 pandemic in burn cases and to prevent these cases completely. The short hospital stay preferred by clinicians after COVID‐19 and possible problems that may arise should be investigated.

Análisis de la Calidad de Vida de los pacientes en tratamiento de hemodiálisis del Hospital San Juan de Dios de Zaragoza

Las fases avanzadas de insuficiencia renal crónica adquieren criterios de enfermedad terminal, siendo necesario tratamiento sustitutivo renal.
Objetivo: Analizar el impacto de la hemodiálisis en la calidad de vida de los pacientes con Insuficiencia Renal Crónica. Metodología: Estudio descriptivo transversal de calidad de vida en 102 pacientes del servicio de hemodiálisis del Hospital San Juan de Dios de Zaragoza a través de los cuestionarios SF-36 y KDQOL. Resultados: Existe un detrimento de calidad vida en las dimensiones de rol físico, salud general, rol emocional, función cognitiva, relaciones sociales y situación laboral. Conclusión: Los pacientes en tratamiento de hemodiálisis ven modificada su calidad de vida en relación a las variables sociodemográficas (sexo, edad, situación laboral y estado civil) y clínicas (tipo de acceso vascular, duración del tratamiento, tiempo con el tratamiento y presencia de comorbilidades).

The impact of surgical site infection on hospitalisation, treatment costs, and health‐related quality of life after vascular surgery

Abstract

Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health‐related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean‐contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30‐day period. Patient‐reported EQ‐5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI‐associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high‐risk vascular patients should be investigated.

2020 the year we would rather forget

International Wound Journal, Volume 17, Issue 6, Page 1555-1555, December 2020.

Frailty leads to higher mortality and hospital use

Commentary on: Keeble, E, Parker, SG, Arora, S, et al. Frailty, hospital use and mortality in the older population: findings from the Newcastle 85+ study. Age Ageing 2019;48:797–802. https://doi.org/10.1093/ageing/afz094.

Implications for practice and research

  • Frailty leads to higher mortality and hospital use.

  • Information about frailty should inform the development of services to meet patient need.

  • Research in the community setting is required to better understand proactive and preventative approaches in frailty management.

  • Context

    Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalisation and mortality. Frailty is a significant determinant of healthcare use and associated costs, both of which also increase as a person nears death. In the UK, and internationally, those aged over 85 years are the fastest growing demographic group. By 2050, the number of people...

    Combining physical and cognitive interventions positively affects gait in older adults with cognitive impairment

    Por: Mitchell · G. · McTurk · V.

    Commentary on: Zhang W, Low LF, Gwynn JD, et al. Interventions to improve gait in older adults with cognitive impairment: a systematic review. J Am Geriatr Soc 2019;67;381–91.

    Implications for practice and research

  • Gait is not solely a biomechanical process. Cognitive factors need to be considered when employing interventions to improve gait in older people.

  • Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs.

  • To improve gait in older people living with mild cognitive impairment, or the early stages of dementia, gait interventions should include strength, balance and functional mobility training in combination with cognitive control training.

  • Context

    The prevalence of gait and balance disorders significantly increases as a person grows older. These disorders affect around 10% people in their 60s and >60% of people in their 80s.1 Recent studies have found a strong link...

    Health discipline students face various direct and indirect types of risks and hazards during education in clinical placements

    Por: Booth · R. · O'Connor · S.

    Commentary on: Graj E, Sheen J, Dudley A, et al. Adverse health events associated with clinical placement: a systematic review. Nurse Educ Today 2019;76:178–190. doi:10.1016/j.nedt.2019.01.024.

    Implications for practice and research

  • Risks and hazards faced by health discipline students in clinical placement settings are commonly subtle, and occur in both direct and indirect fashions to the student.

  • Future research should seek to explore the interrelationship between the type of clinical experience, educational progression and other contextual factors found in clinical placement settings, as related to student risks.

  • Context

    The review completed by Graj et al1 sought to explore the risks and hazards encountered by health discipline students during clinical placements. Primary research completed in this domain has suggested that students commonly face various types of abuse, violence and other health-related occupational hazards during formal training.2 Graj et al1 sought...

    Pedometer-based walking interventions provide sustained increases in physical activity levels, as well as reductions in cardiovascular events and fractures

    Por: Pavagadhi · D. · Car · J.

    Commentary on: Harris T, Limb ES, Hosking F, et al. Effect of pedometer-based walking interventions on long-term health outcomes: prospective 4-year follow-up of two randomised controlled trials using routine primary care data. PLoS Med 2019;16:e1002836.

    Implications for practice and research

  • A primary care pedometer-based intervention can be an effective and scalable approach for increasing physical activity, and potentially improving long-term health outcomes.

  • Further research is needed for testing the effects of comparable physical activity to identify if outcomes differ across diseases depending on the length of follow-up and change in the physical activity levels.

  • Context

    Long-term diseases are a priority health concern globally, and associated with considerable disease burden,1 lowered quality of life,2 morbidity and mortality.1 2 Prompt and evidence-based approaches for the prevention and optimal management of long-term diseases are imperative. Although the association between...

    Statins used for secondary prevention in patients with stroke reduce the risk of further ischaemic strokes and cardiovascular events

    Por: Hill · J. · Hare · M.

    Commentary on: Tramacere, I, Boncoraglio, GB, Banzi, R, et al. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med 2019;17:67. doi:10.1186/s12916-019-1298-5.

    Implications for practice and research

  • The secondary use of statins is effective in reducing the absolute risk of ischaemic stroke and cardiac events in patients who previously have had an ischaemic stroke or transient ischaemic attack (TIA).

  • Further research is required to ascertain which statin is the most effective.

  • Context

    Stroke is one of the major causes of worldwide death and disability, with one in four people predicted to experience a stroke within their lifetime.1 After a stroke or a TIA, there remains a substantial long-term risk of recurrent stroke.2 It is recommended that statins should be used to reduce the risk of recurrent stroke...

    There is an urgent need for evidence-based internationally agreed guidelines for minimising readmissions after paediatric sepsis

    Por: Paul · S. P. · Walsh · H. R.

    Commentary on: Carlton E, Kohne J, Shankar-Hari, et al. Readmission diagnoses after paediatric severe sepsis hospitalisation. Crit Care Med 2019;47:583–90.

    Implications for practice and research

  • Children with coexisting comorbidities when discharged following severe sepsis have a higher rate of readmission as compared with matched hospitalisations for other acute medical conditions.

  • There is a need for internationally agreed evidence-based guidelines/consensus paper to minimise post-sepsis readmissions through identification of potentially preventable factors, appropriate discharge criteria and parental education.

  • More research is required into strategies towards prevention of readmissions following discharge after an episode of severe sepsis in children.

  • Context

    Sepsis is a leading cause of avoidable death across all age groups.1 Attempts have been made to streamline the management pathways in the UK and elsewhere through publication of national guidelines.1 While robust guidelines exist for management of initial sepsis episodes, strategies...

    Producing a successful PhD thesis

    Por: Barrett · D. · Rodriguez · A. · Smith · J.

    All doctoral students strive for the day—after years of often all-consuming study—that their thesis is ready to submit. For both doctoral students and supervisors there is often trepidation about whether the thesis will meet the criteria to merit the award of a Doctor of Philosophy (PhD). As anxieties increase, doctoral students often ask what makes a good PhD, something we explored in a recent ‘Research Made Simple’ article,1 but perhaps the more important question is ‘what makes a PhD student successful?’ In this article we outline the core criteria on which PhD theses are judged and offer suggestions for achieving success.

    How are PhDs assessed

    Traditionally, a PhD involves 3 to 4 years of full-time study (or a longer part-time programme), which is assessed by the student submitting the work they have undertaken as a thesis or—less commonly—a portfolio of published papers and an associated narrative (sometimes...

    Physical activity reduces symptoms of anxiety, but further research is needed to determine a preventative effect

    Por: Singh · S. · Yang · L.

    Commentary on: McDowell, C, Dishman, RK, Gordon, BR, et al. Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am J Prev Med 2019;574:545–56.

    Implications for practice and research

  • The burden of anxiety disorders and symptoms can potentially be reduced by increasing physical activity at the population level.

  • More studies require using prospective designs and rigorous measures for assessing anxiety and dosing of physical activity.

  • Context

    Anxiety is a debilitating1 and costly chronic illness.2 Pharmacological treatment of anxiety disorders and symptoms can be challenging with side effects and expensive for many,3 which makes prevention strategies critical. Physical activity has been previously shown to reduce the symptoms of anxiety and depression.4 Whether physical activity may be effective in preventing anxiety has not yet been previously investigated, presenting a knowledge gap and an opportunity...

    Critical considerations for engaging in inclusive health research with individuals with intellectual disability

    Por: Bobbette · N. · Hamdani · Y.

    Commentary on: Schwartz, AE, Kramer, JM, Cohn ES, et al. "That Felt Like Real Engagement": fostering and maintaining inclusive research collaborations with individuals with intellectual disability. Qual Health Res 2019;30:236–49. doi: 10.1177/1049732319869620.

    Implications for practice and research

  • Individuals with intellectual disabilities (ID) should be involved in co-producing research and evaluating services related to their health and healthcare.

  • Swartz and colleagues’ conceptual model provides valuable insights into factors that enable inclusive research collaborations with individuals with ID and can be used to inform future inclusive health research.

  • Context

    Including the perspectives of individuals with ID in health research and service evaluation is essential to the delivery of high-quality, person-centred healthcare and research that is accessible and reflective of the needs of this group. Inclusive research (IR) is a collaborative approach for working with people with disabilities.1 Guidelines have been specifically developed to support...

    College suicide prevention programmes are most effective when they incorporate students sense of coherence and connectedness in their design

    Por: Ghassemi · A. E.

    Commentary on: Blasco MJ, Vilagut G, Alayo I, et al. First-onset and persistence of suicidal ideation in university students: a one-year follow-up study. J Affect Disord 2019;256:192–204.

    Implications for practice and research

  • Planning strategies for both detection and interventions among students with suicidal ideation to decrease severe suicidal thoughts and behaviours.

  • Creating universal strategies for promoting a sense of membership and connectedness will prevent suicide among first-year college students.

  • Context

    Based on the current evidence suicidal thoughts and behaviour (STB) among university students has shown steady incline. Suicide is the second worldwide cause of death for those between ages 15 and 29.1 Suicidal behaviour (ideation, plan, attempt) has been linked to and stressors such as moving away from established social network, social isolation, issues of sexual identity, and academic and social challenges.2 Considering the significance of the problem, a number...

    Coping with multiple morbidities: Asian perspectives to inform culturally appropriate caregiving

    Por: Zhan · X. · Wenchung · W. · Lin · H. · Jingran · L. · Li · B. · Li · M. T. · Tian Fu · R. · Wu · Y. · Wu · X. · Shi · X. · Lee · A. J. · Shengxiao · X.

    Commentary on: Cheng Cheng, Bai Jie, Yang Cong-Yan et al. Patients' experiences of coping with multiple chronic conditions: a qualitative descriptive study. J Clin Nurs, 2019, 28: 4400–11.

    Implications for practice and research

  • Healthcare professionals must acknowledge cultural differences in coping strategies and must communicate effectively to inform caregiving.

  • Further qualitative, descriptive studies are required to explore the needs of patients so this information can inform culturally sensitive and appropriate care.

  • Context

    As prevalence of multiple chronic conditions (MCC) increases, financial, personal and institutional burdens will rise.1 Complexities require more information on polypharmacy, disease management and assessments of impact on service provision.2 This qualitative study3 evaluates how patients cope with their diagnoses and manage their own symptoms. It offers a cultural perspective on the burdens of chronic disease management and presents guidance on coping strategies used in Chinese...

    Family perspectives need considering as part of the assisted dying process

    Por: Bravo · P. H.

    Commentary on: Gamondi C, Fusi-Schmidhauser T, Oriani A, et al. Family members’ experiences of assisted dying: a systematic literature review with thematic synthesis. Palliat Med 2019;33:1091–105. doi: 10.1177/0269216319857630.

    Implications for practice and research

  • Family support positively influences patient engagement in assisted dying.

  • Future research is needed to identify and incorporate family needs into evidenced-based assisted dying guidelines.

  • Context

    Though assisted dying is a growing practice, it is not legally permissible throughout the world. Currently, only 176 million people worldwide have legal access to this practice.1 It encompasses two practices: assisted suicide and active euthanasia.2 While rates of assisted dying have increased in countries legally allowing the practice, family requirements differ geographically based on the model of assisted dying used.1 This variability in family responsibility can result in differing family experiences. This study focussed on identifying and understanding these experiences...

    Patients prefer bedside handover and wish to be active partners in it

    Por: Hu · J.

    Commentary on: Oxelmark, L, Whitty, JA, Ulin, K, et al. Patients prefer clinical handover at the bedside; nurses do not: evidence from a discrete choice experiment. International Journal of Nursing Studies. Epub ahead of print: 27 Sep 2019. https://doi.org/10.1016/j.ijnurstu.2019.103444

    Implications for practice and research

  • It is important to have patients as active partners in the team during bedside handovers and have their voices heard.

  • Future qualitative studies are warranted to explore the reasons for individual preferences and identify the barriers and facilitators of implementing bedside handover.

  • Context

    Clinical handover is a valuable source of patient health information for nurses and patients. Numerous studies have found that bedside handover could significantly enhance the delivery of relevant information and decrease miscommunication between patients and nurses.1 Besides, bedside handover could increase patient participation and safety.2 However, the implementation of bedside handover...

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