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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.

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.

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...

    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.

    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...

    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...

    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...

    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...

    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...

    Repeated hospital admissions are missed opportunities to offer better end-of-life care for people with dementia

    Por: Anderson · C.

    Commentary on: Leniz J, Higginson IJ, Stewart R, et al. Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study. Age and Ageing 2019:afz052. doi: 10.1093/ageing/afz052

    Implications for practice and research

  • Research: explorative study with healthcare professionals to identify their clinical reasoning when admitting to hospital people with dementia for end-of-life care.

  • Practice: ensure advanced directives are identified for people admitted to hospital with dementia.

  • Context

    Around 46 million people worldwide have a diagnosis of dementia. Caring for people with dementia at the end of life has significant economic implications.1 Hospital admission is not always the preferred option for people with dementia for end-of-life care. This study explores the number of transitions to hospital that people with dementia who need end-of-life care undergo. They consider, in particular, multiple admissions in...

    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...

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