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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.

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.

2020 the year we would rather forget

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

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 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...

    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...

    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...

    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...

    Nursing interventions improve preparedness, competence, reward and burden of family caregivers in end-of-life care at home

    Por: Anagnostou · D.

    Commentary on: Becqué YN, Rietjens JAC, van Driel A, et al. Nursing interventions to support family caregivers in end-of-life care at home: a systematic narrative review. Int J Nurs Stud 2019;7:28–39. https://doi.org/10.1016/j.ijnurstu.2019.04.011

    Implications for practice and research

  • Nurses should provide individualised interventions to support family caregivers in end-of-life-care at home.

  • Multicomponent interventions have the potential to address the complex needs of family caregivers.

  • Future research needs to establish effective interventions and their related components.

  • Context

    Informal family caregivers play a crucial role in end-of-life care, especially in the community. However, family caregivers are known to have high needs and psychological morbidity,1 including fatigue, sleep problems, depression, anxiety and burnout. Palliative care aims to provide psychosocial support to patients and families facing terminal illness. Interventions that aim to support family caregivers are increasing and have been reported in the literature.

    Nurses night shift performance improves through taking scheduled naps

    Por: Izadi · N.

    Commentary on: Zion N, Schohat T. Let them sleep: the effects of a scheduled nap during the night shift on sleepiness and cognition in hospital nurses. J Adv Nurs 2019. doi: 10.1111/jan.14031. [Epub ahead of print 22 April 2019].

    Implications for practice and research

  • The implementation of new strategies to allow nurses to nap could have positive impact on nurse performance.

  • Further research is needed to generalise these findings to male shift workers and other shift schedules.

  • Context

    Healthcare workers who work in rotating shifts may experience sleepiness and reduction of job performance.1 2 Further, several studies observed that night shifts can negatively affect physical, psychological well-being and patient safety.3 There are some recommended interventions, including naps, caffeine consumption and brightness exposure, to reduce these adverse effects.4–6 The aim of this study...

    Bridging anticoagulation therapy with low molecular weight heparin in patients with atrial fibrillation following a stroke is associated with adverse events

    Por: Kennedy · R.

    Commentary on: Altavilla R, Caso V, Bandini F, et al. Anticoagulation after stroke in patients with atrial fibrillation. Stroke 2019;508:2093–100.

    Implications for practice and research

  • Healthcare professionals need to be aware that bridging anticoagulation therapy with low molecular weight heparin (LMWH) in patients with atrial fibrillation following a stroke is associated with a higher rate of recurrent ischaemic and haemorrhagic events compared with patients who do not receive bridging therapy.

  • Strategies to ensure adherence to the guidelines need to be devised and implemented within the clinical setting.

  • Context

    Patients with cardioembolic stroke and non-valvular atrial fibrillation are at a high risk of early stroke recurrence.1 Oral anticoagulation therapy (OAC) in the form of vitamin K antagonists (VKAs) and non–vitamin-K oral anticoagulants (NOACs) are the medical therapy of choice in the secondary prevention of stroke. American Stroke guidelines2 recommend the initiation...

    Primary care suicide screening: the importance of comprehensive clinical assessment

    Por: Clibbens · N.

    Commentary on: Richards JE, Hohl SD, Whiteside U, et al. If you listen, I will talk: the experience of being asked about suicidality during routine primary care. J Gen Intern Med 2019;34:2075–82. doi: 10.1007/s11606-019-05136-x.

    Implications for practice and research

  • Suicide screening in primary care is acceptable to people when they feel cared for, the assessor has time to listen and they are informed about what will happen.

  • Suicide screening should not be limited to the use of measurement tools, more accurate assessment is achieved using a comprehensive clinical assessment.

  • Context

    Suicide is preventable yet worldwide ~800 000 people die by suicide every year. Suicide prevention is a global public health priority1 and primary care providers are important gatekeepers in identifying people experiencing suicidal thoughts. Factors influencing the accuracy of suicide assessment include stigma preventing disclosure and fear of consequences of disclosure. Suicidal thoughts...

    When a parent is dying: how we can do more to support families and children with a dying parent

    Por: Pinto · C. · Pinto · S.

    Commentary on: Hanna JR, McCaughan E, Semple CJ. Challenges and support needs of parents and children when a parent is at end of life: a systematic review. Palliat Med 2019;338:1017–1044. doi: 10.1177/0269216319857622.

    Implications for practice and research

  • When a parent is dying, an honest discussion should be made with the children to prepare them for an imminent bereavement. Community awareness is important for better support networks for grieving families.

  • Further research is needed to explore ways of supporting dying parents to have conversations with children of different ages, family settings and cultural backgrounds.

  • Context

    Dying parents of dependent children are faced with accepting their own impending death as well as supporting their children to understand what is happening and prepare them for when death occurs. Such a challenge needs support from healthcare professionals to facilitate a positive approach that prepares the children for loss...

    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...

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