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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.

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.

Screening nutricional en pacientes con cáncer ginecológico y su asociación con complicaciones posoperatorias

Objetivo principal: Determinar la prevalencia de riesgo de desnutrición de las pacientes hospitalizadas previamente a la cirugía inicial de cáncer ginecológico mediante dos herramientas de cribado nutricional. Analizar la asociación existente entre el riesgo de desnutrición y la aparición de complicaciones postoperatorias. Metodología: Estudio observacional de cohortes prospectivo de mujeres ingresadas en la planta de ginecolo-gía de un hospital terciario pendientes de la cirugía inicial de su cáncer ginecológico. Se utilizaron los test de cribado nutricional NRS- 2002 y MUST para evaluar la prevalencia de riesgo de desnutrición. El poder predictivo independiente de los test de cribado nutricional se determinó mediante modelos de regresión logística uni y multivariante. Resultados principales: Se incluyeron 53 pacientes con cáncer ginecológico. La prevalencia de pacientes en riesgo de desnutrición detectada por el cuestionario NRS- 2002 fue del 17% frente al 3,9% según el test MUST. La incidencia acumulada de complicaciones durante el posoperatorio y la estancia hospitalaria fue superior en los pacientes desnutridos según NRS-2002 (40% vs. 11,6%; p=0,053; 3,64 (DE 4,4) días vs. 8,78(DE 3,99) días; p=0,000). En análisis multivariante el poder predictivo del test NRS- 2002 para complicaciones posoperatorias quedó en el límite de la significación estadística tras ajuste para edad y cáncer de ovario (OR = 5,93; IC 95% 0,85-41,37; p = 0,073). Conclusión principal: El NRS-2002 es una herramienta útil para valorar el riesgo de desnutrición en pacientes con cáncer ginecológico pendientes de cirugía primaria.

Personalised, patient-inclusive clinical medication reviews can reduce drug-related problems in older patients

Por: Acorn · M.

Commentary on: Verdoorn S, Kwint HF, Blom JW, et al. Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: a randomised controlled trial (DREAMeR-study). PLoS Med 2019;16:e1002798. doi: 10.1371/journal.pmed.1002798.

Implications for practice and research

  • Optimising personalised and tailored clinical medication reviews (CMRs) for older patients can reduce drug-related problems (DRPs) due to multimorbidity and polypharmacy.

  • An approach to the CMR guided by patient goals and preferences are beneficial to quality of life and well-being.

  • Context

    A CMR is a structured, critical examination of a patient’s medications with the objective of reaching an agreement about treatment, optimising medicine impact, minimising medication-related issues and reducing waste. Limited evidence exists on the CMR intervention ability to improve patient outcomes. The DREAMeR study looks at polypharmacy in older persons who can benefit from a patient-centred CMR...

    Frailty is a predictor of mortality in surgical emergency admissions among UK adults

    Por: Nimura · M. · Kojima · G.

    Commentary on: Hewitt J, Carter B, McCarthy K, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019;48:388–94. doi: 10.1093/ageing/afy217.

    Implications for practice and research

  • Frailty assessment for emergency surgical patients may be useful in prognostication and outcome improvement.

  • Further research is needed to improve outcomes by identifying frail older people and administering interventions while still in the community.

  • Context

    Frailty is a term that has been well-established and associated with deteriorated capacity to maintain homoeostasis and vulnerability to stressors.1 Various studies have demonstrated the links between frailty and its adverse outcomes.2 3 While many of the previous studies focused on its negative impacts on older populations, evidence on frailty among emergency surgical patients is scarce. Hewitt et al4 examined frailty status among adult patients aged 18...

    The integration of personal narratives into hospital-based palliative care can relieve patient psychosocial and existential suffering

    Por: Acorn · M.

    Commentary on: Gundtof Rokiaer S, Missel M, Bergenholtz HM, et al. The use of personal narratives in hospital-based palliative care interventions: An integrative literature review. Palliat Med 2019; 1–17.

    Implications for practice and research

  • Personal narrative interventions can be successfully implemented in hospital-based palliative care to ease psychosocial and existential suffering of patients.

  • An opportunity for research exists into the role and impact of personal narrative interventions more broadly in palliative care and beyond the hospital setting.

  • Context

    Patients with life-threatening illnesses continue to primarily receive care in the hospital setting. Although palliative care is evolving, there remains an emphasis on curative care in the hospital setting1. The focus on curative care often leads patients to experience a lack of psychosocial support and unmet emotional needs.2 This review by Roikjaer and colleagues examined the role that narrative interventions can play...

    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...

    Support and guide parents on infants problems with home visits and a focus on maternal mental health

    Por: Namnabati · M.

    Commentary on: Olsen AL, Ammitzboll J, Olsen EM, et al. Problems of feeding, sleeping and excessive crying in infancy: a general population study. Arch Dis Child 2019;104:1034–41.

    Implications for practice and research

  • This study identified some regulatory problems such as feeding, sleeping and excessive crying during three periods of infancy through a set of preprogrammed home visits.

  • Parental health has been found to be closely related to infant feeding and sleeping patterns.

  • Providing parents with a strategy to cope with problems with infant feeding and sleeping patterns can reduce parental stress and improve the health of infants.

  • Future research can focus on understanding problems in early and late infancy to provide specific support for parents and develop guidelines for policymakers.

  • Context

    The most common problems among infants are excessive crying, and feeding and sleeping problems, which may occur individually or together. These...

    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...

    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...

    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...

    Nurses should recognise that focusing only on the resolution of physical symptoms may not be enough to overcome the psychosocial implications of living with a chronic disease

    Por: Ma · S.

    Commentary on: Byron C, Cornally N, Burton A, et al. Challenges of living with and managing inflammatory bowel disease: a meta-synthesis of patients’ experiences. J Clin Nurs 2020;29:305–19. doi: 10.1111/jocn.15080.

    Implications for future practice and research

  • Nurses are well situated to coach people living with chronic conditions to recognise and utilise healthy practical and emotional coping strategies.

  • Future research should not only explore how people with inflammatory bowel disease manage the challenges they face but what the scope is for specialist nurse support.

  • Context

    Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract that is associated with embarrassing signs and symptoms that include rectal bleeding, diarrhoea, faecal urgency and abdominal pain. Byron et al have provided a meta-synthesis of patients experiences with this condition1 and an update on previous work conducted by Kemp et al.2 The authors...

    Prevention of pressure injury in the operating room: Heels operating room pressure injury trial

    Abstract

    The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P = .001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery.

    Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm

    Abstract

    Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or “critically colonised” wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a “window of opportunity” may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone‐iodine (PVP‐I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP‐I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross‐resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP‐I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm‐infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non‐healing wounds due to critical colonisation or biofilm, using PVP‐I.

    Social participation of people with chronic wounds: A systematic review

    Abstract

    Living with chronic ulcers can be burdensome and restrictive, with regard to not only physical and psychological but also social well‐being. This review aims to analyse social participation in patients with chronic wounds and to compare results across different wound types. A search string was applied in several electronic databases. Results were screened according to predefined inclusion and exclusion criteria. Data of eligible articles were extracted and synthesised narratively. The search revealed 42 eligible publications. Only minor differences across different ulcer types could be detected. Overall, family members were the main social contacts for patients; they often provided wound care and emotional support. Patients had few non‐family relations, but those existing were often very close. Patients felt guilty as their condition imposed burden on family and friends, as well. A close relationship with nurses was described. Restrictions were caused by direct and indirect consequences of the wound. Overall, social support and social connections were reduced in wound patients. Inconsistent results were found regarding social isolation. In summary, people with chronic wounds experience impairments in all aspects of social participation. Therefore, social participation deserves increased attention in routine care both as a trigger of burden and as an outcome of therapy.

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