Special Issue "Wound Care"

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 April 2015)

Special Issue Editor

Guest Editor
Prof. Zena Moore (Website)

Professor & Head of the School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
Interests: wound healing and tissue repair; pressure ulcer prevention and management; quantitative research methods; design, conduct and analysis of clinical trials; epidemiology; clinical nurse specialists; evidence based practice; research implementation; systematic reviews; quality of life; health economics

Special Issue Information

Dear Colleagues,

Wounds and the many associated problems have challenged health care providers for centuries and today, despite the wealth of knowledge available, neither the incidence nor prevalence of wounds is reducing. Furthermore, in view of our changing demographic profile and the projected increase in the older population, it is likely that wound management will become an ever increasing burden to the individual, health care services and society as a whole. The annual incidence of wounds in the EU-27 is approximately 4 million, and between 25% and 50% of acute hospital beds are occupied by patients with a wound, with up to 60% of these representing non-healing wounds (infected surgical wounds, pressure ulcers, leg/foot ulcers) The increasing prevalence and incidence of non-wounds healing is closely linked with quality of care and, as such, these rising figures reduce society’s confidence in the health service’s ability to deliver care that is timely, appropriate and effective. Thus, for those involved in this specialist area of clinical practice, the fundamental goal is to improve clinical outcomes, reduce the burden of wounds and improve health related quality of life.

Prof. Zena Moore
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed Open Access quarterly journal published by MDPI.

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Keywords

  • wound care
  • pressure ulcer
  • diabetic foot ulcer
  • leg ulcer
  • non-healing wound
  • health related quality of life
  • cost effectiveness

Published Papers (18 papers)

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Research

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Open AccessArticle Tailoring International Pressure Ulcer Prevention Guidelines for Nigeria: A Knowledge Translation Study Protocol
Healthcare 2015, 3(3), 619-629; doi:10.3390/healthcare3030619
Received: 22 April 2015 / Revised: 2 July 2015 / Accepted: 3 July 2015 / Published: 28 July 2015
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Abstract
Background: The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in [...] Read more.
Background: The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provides the most current evidence based strategies to prevent Pressure Ulcer (PU). The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. Aim: To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Methods: Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. Results: A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Conclusion: Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics
Healthcare 2015, 3(3), 574-585; doi:10.3390/healthcare3030574
Received: 1 May 2015 / Revised: 28 June 2015 / Accepted: 9 July 2015 / Published: 17 July 2015
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Abstract
A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful [...] Read more.
A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions resulted in a decrease in the prevalence of HAPU at UMH from 11.7% of stage II to IV ulcers in the second quarter, 2009 to 2.1% the third quarter. The rate remained at or near the 2009 UMH benchmark of 3.1% until the first quarter of 2012 when the rate rose to 4.1%. At that time new skin products were introduced into practice and continuing re-education was provided. The rate of HAPU dropped to 2.76% by the second quarter of 2012 and has remained steadily low at 1%–2% for nine consecutive quarters. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Molecular Wiring in Smart Dressings: Opening a New Route to Monitoring Wound pH
Healthcare 2015, 3(3), 466-477; doi:10.3390/healthcare3030466
Received: 30 April 2015 / Revised: 7 June 2015 / Accepted: 15 June 2015 / Published: 25 June 2015
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Abstract
It has been proposed that fluctuations in wound pH can give valuable insights into the healing processes in chronic wounds, but acquiring such data can be a technological challenge especially where there is little sample available. Developments in voltammetric pH sensing have [...] Read more.
It has been proposed that fluctuations in wound pH can give valuable insights into the healing processes in chronic wounds, but acquiring such data can be a technological challenge especially where there is little sample available. Developments in voltammetric pH sensing have opened up new avenues for the design of probes that can function in ultra-small volumes and can be inherently disposable but, as yet few can meet the demands of wound monitoring. A preliminary investigation of the pH response of a new redox wire prepared from a peptide homopolymer of tryptophan is presented and its potential applicability as a sensing material for use in smart dressings is critically discussed. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
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Open AccessArticle Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care
Healthcare 2015, 3(2), 417-428; doi:10.3390/healthcare3020417
Received: 29 April 2015 / Revised: 24 May 2015 / Accepted: 25 May 2015 / Published: 9 June 2015
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Abstract
Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence [...] Read more.
Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care
Healthcare 2015, 3(1), 20-35; doi:10.3390/healthcare3010020
Received: 8 August 2014 / Revised: 15 December 2014 / Accepted: 14 January 2015 / Published: 22 January 2015
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Abstract
Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new [...] Read more.
Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Managing Everyday Life: A Qualitative Study of Patients’ Experiences of a Web-Based Ulcer Record for Home-Based Treatment
Healthcare 2014, 2(4), 492-504; doi:10.3390/healthcare2040492
Received: 8 August 2014 / Revised: 28 November 2014 / Accepted: 2 December 2014 / Published: 15 December 2014
Cited by 1 | PDF Full-text (384 KB) | HTML Full-text | XML Full-text
Abstract
Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is [...] Read more.
Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited research on patients’ use of e-health services for home-based ulcer treatment. This article reports an exploratory qualitative study of the first Norwegian web-based counselling service for home-based ulcer treatment, established in 2011 by the University Hospital of North Norway (UNN). Community nurses, general practitioners (GPs) and patients are offered access to a web-based record system to optimize ulcer care. The web-based ulcer record enables the exchange and storage of digital photos and clinical information, by the use of which, an ulcer team at UNN, consisting of specialized nurses and dermatologists, is accessible within 24 h. This article explores patients’ experiences of using the web-based record for their home-based ulcer treatment without assistance from community nurses. Semi-structured interviews were conducted with a total of four patients who had used the record. The main outcomes identified were: autonomy and flexibility; safety and trust; involvement and control; and motivation and hope. These aspects improved the patients’ everyday life during long-term ulcer care and can be understood as stimulating patient empowerment. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT
Healthcare 2014, 2(4), 417-428; doi:10.3390/healthcare2040417
Received: 19 June 2014 / Revised: 28 August 2014 / Accepted: 22 September 2014 / Published: 30 September 2014
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Abstract
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its [...] Read more.
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus® dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle The Role of Preference on Outcomes of People Receiving Evidence-Informed Community Wound Care in Their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230)
Healthcare 2014, 2(3), 401-416; doi:10.3390/healthcare2030401
Received: 13 May 2014 / Revised: 1 August 2014 / Accepted: 4 September 2014 / Published: 19 September 2014
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Abstract
This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose [...] Read more.
This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a “choice” cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL), pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group), and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group). Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Sustaining Behavior Changes Following a Venous Leg Ulcer Client Education Program
Healthcare 2014, 2(3), 324-337; doi:10.3390/healthcare2030324
Received: 16 April 2014 / Revised: 18 August 2014 / Accepted: 22 August 2014 / Published: 4 September 2014
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Abstract
Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the “Leg Ulcer Prevention Program” (LUPP) for people with a venous leg ulcer. [...] Read more.
Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the “Leg Ulcer Prevention Program” (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n = 49) examination of behavior maintenance across an average 8 to 9 months period. Physical activity levels increased over time. Leg elevation, calf muscle exercises, and soap substitute use were seen to fluctuate over the follow up time points. The use of a moisturizer showed gradual decline over time. The provision of a client-focused venous leg ulcer program was associated with behavior changes that had varied sustainability across the evaluation period. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle The Patient’s Conceptions of Wound Treatment with Negative Pressure Wound Therapy
Healthcare 2014, 2(3), 272-281; doi:10.3390/healthcare2030272
Received: 31 March 2014 / Revised: 10 June 2014 / Accepted: 2 July 2014 / Published: 21 July 2014
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Abstract
During the last two decades, additional methods have been developed in wound care where traditional treatments have been insufficient. Negative pressure wound therapy (NPWT) is one such method. This method has been described in multiple studies, but still, many pieces of the [...] Read more.
During the last two decades, additional methods have been developed in wound care where traditional treatments have been insufficient. Negative pressure wound therapy (NPWT) is one such method. This method has been described in multiple studies, but still, many pieces of the puzzle are missing to get a complete picture of NPWT’s impact on the patient’s health-related quality of life and how the patient experiences the treatment. The purpose of this study was to describe the patient’s conceptions of wound treatment with NPWT. The study was inspired by phenomenography, and eight interviews were conducted with patients treated with NPWT. The results of the study were grouped into two main categories: stress and adaptation. Three descriptive categories were presented under stress: personal environment, competence of the nursing staff and organization and continuity of the dressing changes. Two descriptive categories were presented under adaptation: knowledge and creativity and confidence with the healthcare. Patients were affected by the treatment, and at times, the stress meant that they had difficulty coping. The most common source of stress observed in this study was the care environment, particularly the organization of the dressing changes and deficiencies in the healthcare personnel’s competence. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessArticle Antifungal Effect of Non-Woven Textiles Containing Polyhexamethylene Biguanide with Sophorolipid: A Potential Method for Tinea Pedis Prevention
Healthcare 2014, 2(2), 183-191; doi:10.3390/healthcare2020183
Received: 13 January 2014 / Revised: 3 March 2014 / Accepted: 21 March 2014 / Published: 8 April 2014
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Abstract
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal [...] Read more.
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal invasion. This study investigates the antifungal effects, cytotoxicity, permeability, and efficacy of non-woven textiles containing polyhexamethylene biguanide (PHMB) mixed with sophorolipid. Permeability of PHMB with varying concentrations of sophorolipid was assessed via a cultured skin model. Stratum corneum PHMB concentration was quantified by polyvinylsulphuric acid potassium salt titration and cytotoxicity was assayed via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. Antifungal effects were evaluated via a new cultured skin/Trichophyton mentagrophytes model, with varying PHMB exposure duration. Clinically-isolated Trichophyton were applied to the feet of four healthy volunteers and then immediately treated with the following methods: washing with soap, a non-woven textile with PHMB, the textile without PHMB, or without washing. Fungal colony forming units (CFUs) were evaluated after one of these treatments were performed. Sophorolipid with various concentrations significantly facilitated PHMB permeation into the stratum corneum, which was not in a dose-dependent manner. Significant PHMB antifungal effects were achieved at 30 min, with low cytotoxicity. Textiles containing PHMB significantly reduced CFU of fungi in healthy volunteers to levels comparable to soap washing. Our results indicate the utility of this product for tinea pedis prevention in clinical settings. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available

Review

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Open AccessReview The Importance of the Management of Infectious Complications for Patients with Left Ventricular Assist Device
Healthcare 2015, 3(3), 750-756; doi:10.3390/healthcare3030750
Received: 1 May 2015 / Revised: 31 July 2015 / Accepted: 18 August 2015 / Published: 26 August 2015
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Abstract
A left ventricular assist device (LVAD) therapy is the viable option for patients with advanced heart failure as a bridge to transplantation, bridge to recovery, or destination therapy. Although application of LVAD support has become a standard option, serious complications or adverse [...] Read more.
A left ventricular assist device (LVAD) therapy is the viable option for patients with advanced heart failure as a bridge to transplantation, bridge to recovery, or destination therapy. Although application of LVAD support has become a standard option, serious complications or adverse events related with LVAD remain a concern. LVAD-related infection including driveline infection (DLI) and bloodstream infection (BSI) is one of the serious clinical matters for LVAD patients, and especially BSI leads to the high incidence of mortality. The LVAD-related infections negatively impact patient’s quality of life. Therefore, control of infection is one of the primary goals of management in LVAD patients. Several efforts including early and appropriate intervention including antibiotics and wound care may contribute to avert the progress into BSI from localized DLI. Particularly, there are clinical secrets in how to use antibiotics and how to treat wound care in LVAD patients. The rational way of thinking for wound care will be introduced in this review. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Electrical Stimulation and Cutaneous Wound Healing: A Review of Clinical Evidence
Healthcare 2014, 2(4), 445-467; doi:10.3390/healthcare2040445
Received: 1 July 2014 / Revised: 18 September 2014 / Accepted: 30 September 2014 / Published: 27 October 2014
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Abstract
Electrical stimulation (ES) has been shown to have beneficial effects in wound healing. It is important to assess the effects of ES on cutaneous wound healing in order to ensure optimization for clinical practice. Several different applications as well as modalities of [...] Read more.
Electrical stimulation (ES) has been shown to have beneficial effects in wound healing. It is important to assess the effects of ES on cutaneous wound healing in order to ensure optimization for clinical practice. Several different applications as well as modalities of ES have been described, including direct current (DC), alternating current (AC), high-voltage pulsed current (HVPC), low-intensity direct current (LIDC) and electrobiofeedback ES. However, no one method has been advocated as the most optimal for the treatment of cutaneous wound healing. Therefore, this review aims to examine the level of evidence (LOE) for the application of different types of ES to enhance cutaneous wound healing in the skin. An extensive search was conducted to identify relevant clinical studies utilising ES for cutaneous wound healing since 1980 using PubMed, Medline and EMBASE. A total of 48 studies were evaluated and assigned LOE. All types of ES demonstrated positive effects on cutaneous wound healing in the majority of studies. However, the reported studies demonstrate contrasting differences in the parameters and types of ES application, leading to an inability to generate sufficient evidence to support any one standard therapeutic approach. Despite variations in the type of current, duration, and dosing of ES, the majority of studies showed a significant improvement in wound area reduction or accelerated wound healing compared to the standard of care or sham therapy as well as improved local perfusion. The limited number of LOE-1 trials for investigating the effects of ES in wound healing make critical evaluation and assessment somewhat difficult. Further, better-designed clinical trials are needed to improve our understanding of the optimal dosing, timing and type of ES to be used. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds
Healthcare 2014, 2(3), 356-400; doi:10.3390/healthcare2030356
Received: 26 May 2014 / Revised: 8 July 2014 / Accepted: 19 August 2014 / Published: 10 September 2014
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Abstract This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Exploring Resilience When Living with a Wound — An Integrative Literature Review
Healthcare 2014, 2(3), 346-355; doi:10.3390/healthcare2030346
Received: 13 May 2014 / Revised: 10 July 2014 / Accepted: 26 August 2014 / Published: 5 September 2014
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Abstract
The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An [...] Read more.
The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessReview Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups
Healthcare 2014, 2(3), 299-314; doi:10.3390/healthcare2030299
Received: 18 March 2014 / Revised: 3 July 2014 / Accepted: 10 July 2014 / Published: 25 July 2014
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Abstract
The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two [...] Read more.
The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention’s characteristics, outcomes, and sustainability. Methods: This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. Results: The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled “brainstormed ideas”, focusing on strategies for improving the innovation. Implications: Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available

Other

Jump to: Research, Review

Open AccessCase Report Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention
Healthcare 2015, 3(3), 586-592; doi:10.3390/healthcare3030586
Received: 12 May 2015 / Revised: 7 July 2015 / Accepted: 9 July 2015 / Published: 17 July 2015
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Abstract
Lower extremity wounds and falls are on the rise with the demographics and projected aging population. Diabetes and heart disease supersede cancer deaths. A basic foot exam—performed routinely on patients identified as high risk allows time for early intervention and prevention. A [...] Read more.
Lower extremity wounds and falls are on the rise with the demographics and projected aging population. Diabetes and heart disease supersede cancer deaths. A basic foot exam—performed routinely on patients identified as high risk allows time for early intervention and prevention. A Certified Foot and Nail Care Nurse (CFCN) who evaluates clients on a regular basis, conducts a comprehensive lower extremity exam for loss of protective sensation (LOPS) and compromised peripheral blood flow is more likely to provide needed care in a timely manner. Why a nurse? Because nurses who have the level of education, expertise through acquired training, and are board certified are competent to assess, educate, provide intervention, and refer. Utilizing CFCNs is cost-effective and efficient. CFCN is utilized as a member of the multidisciplinary team. Nurses are educators and education is an effective method for prevention. Nurses, as the most trusted health care provider, communicate, establish rapport, and develop sustaining relationships. Utilizing the Wound Ostomy Continence Nurses’ Credentialing Board (WOCNCB) CFCN raises the standard of care substantially and reduces overall costs to life, limbs, and dollars. This innovation in practice improves outcomes, patient satisfaction, and safety while reducing hospital admissions. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available
Open AccessCase Report A Rare Case of Aggressive Digital Adenocarcinoma of the Lower Extremity, Masquerading as an Ulcerative Lesion that Clinically Favored Benignancy
Healthcare 2014, 2(3), 315-323; doi:10.3390/healthcare2030315
Received: 18 June 2014 / Revised: 2 August 2014 / Accepted: 15 August 2014 / Published: 27 August 2014
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Abstract
A rare case report of Aggressive Digital Adenocarcinoma (ADPCa) is presented complete with a literature review encompassing lesions that pose potential diagnostic challenges. Similarities between basal cell carcinoma (BCC), marjolin’s ulceration/squamous cell carcinoma (MSCC) and ADPCa are discussed. This article discusses potential [...] Read more.
A rare case report of Aggressive Digital Adenocarcinoma (ADPCa) is presented complete with a literature review encompassing lesions that pose potential diagnostic challenges. Similarities between basal cell carcinoma (BCC), marjolin’s ulceration/squamous cell carcinoma (MSCC) and ADPCa are discussed. This article discusses potential treatment options for ADPCa and the need for early biopsy when faced with any challenging lesion. An algorithmic approach to ADPCa treatment based on the most current research is recommended. Full article
(This article belongs to the Special Issue Wound Care) Print Edition available

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Review
Title: Complex Abdominal Wall Reconstruction
Authors:
Miss S Das Mohapatra DNB, FRCS; Locum Consultant Colorectal Surgeon, St George’s Hospital NHS Trust, London SW17 0QT; E-Mail: mittydm@yahoo.com; Alastair C Windsor MD, FRCS; Consultant Colorectal Surgeon, UCLH, London NW1 2B; E-Mail: alwindsor@aol.com
Abstract:
Abdominal wall defects arise as a result of one or more missing component layers of the abdominal wall. A multiplicity of surgical procedures are associated with complex, recurrent abdominal wall defects, which can occur as a result of failed endeavor at previous repair, trauma, infection, radiation, necrosis, or malignancy. In the acute setting post operative open abdominal wound also poses a significant challenge. There has been a balanced increase in availability of a variety of synthetic materials and biological meshes for the repair of such defects. The use of prosthetic materials is now being replaced by the biologic mesh due to the perceived reduction in infection, recurrence and mesh extrusion rates. This review discusses the pros and cons of the currently available reconstruction options for such complex defects in the abdominal wall.

Title: The application of bactericidal silver nanoparticles in wound treatment systems
Authors:
Geewoo Nam and Joon Myong Song*
Affiliation:
College of Pharmacy, Seoul National University, Seoul 151-742, South Korea
Abstract:
Even with the high level of prevalence of wounds, the medical technology of efficiently managing skin damage is still primitive. Wound healing is a complex and significant process of the human body. An immeasurable number of cellular and chemical actions are involved in the multi-phased restoration. Disruption of any of these processes may present problems for the time-sensitive healing of the skin. Bacterial infection is one of the major obstacles of proper wound healing that may compromise the health of the patient. Thus, the use of antibacterial activity in wound management systems is imperative in keeping the wound bacteria-free. Silver has been used historically to treat wounds for their bactericidal properties to treat wounds. More specifically, Silver nanoparticles have been reported for their enhanced antibacterial activity. This review explores the application of various types of silver nanoparticles in wound treatments.

Title: Restoring Quality of Life for Patients with Infected Acute Wounds
Authors:
Linda LL Benskin
Affiliations:
Church of Christ Mission Clinic, Yendi, Ghana, and Ferris Mfg. Corp., Fort Worth, TX.
Abstract: Patients with acute wounds may not seek medical assistance until their wounds are severely infected. Keeping the wounds clean, decreasing pain, and a quick return to normal activities are these patients’ primary goals. At our clinic in northern Ghana, we found that polymeric membrane dressings (PMDs) efficiently met these needs. PMDs can provide dramatic pain relief by subduing and focusing the nociceptor response. PMDs’ components work with the body to donate moisture to dry wound areas while absorbing excess exudate. PMDs’ non-toxic cleansing system continuously atraumatically loosens slough from the wound bed, pulling it onto the PMD to be discarded at dressing changes. This process usually keeps wounds clean without routine rinsing. Three example patients are described. After initial cleansing/debriding, an appropriate configuration of PMDs was applied to all exposed surfaces of the wounds. Dressings were simply replaced when saturated, usually without rinsing. All three patients’ wounds healed quickly without return of infection. Managing these infected acute wounds with PMDs allowed us to meet patient quality of life goals: freedom from infection, decreased pain, quick healing, and minimal inconvenience. Because PMDs have a built-in continuous cleansing system, these patients also required very little clinic staff time through complete wound closure.
Keywords:
polymeric membrane dressings; PMD; infected; wound; acute; cost; efficient; pain; quality of life; clean

Title: Pressure ulcer in Norway — a snapshot of prevalence across various care settings and recommendations for improved preventive care.
Authors:
Johansen1, E., Bakken1, L. and Moore2, Z.
Affiliations: 1 Buskerud and Vestfold University College, Drammen, Norway. 2 Royal College of Surgeons in Ireland, Dublin, Ireland.
Abstract:
Pressure ulcers (PU) are common in all care settings although most ulcers are preventable. Much evidence exist on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. 17 postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students discussed existing care provision and the potential for improved practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, considerable geographical variations exist in both prevalence and available preventive care. Therefore, Norwegian patients at risk receive differences in care across institutions and home care districts. Recommendations for improvements are based on the Norwegian Patient Safety Programme. In order to ensure systematic application of quality standards across care settings, several aspects needs further attention, for example the requirement for equipment to be readily available, development of competency among staff and not least, enhanced attention to PU prevention across all care sectors.
Keywords:
Pressure ulcer epidemiology, prevalence, prevention, Norway

Title: Development of new polysaccharide-based fibres for moderate to heavy bleeding wounds
Authors:
M. Miraftab, I. R. Sweeney and R. Masood
Affiliations:
University of Bolton
Keywords:
Wound dressings, Alginate, Chitosan, Psyllium

Title: Improving Educational, Clinical and Economic Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP) at a 560 bed Academic Medical Center in South East, FL
Authors:
Amparo Cano, Daniel L. Young, Hope Stamp, Joaquin, Fortunata, Jennifer A. Lopez, Lori Lupe, Stephanie Moss, and Debbie Anglade.
Affiliations: 1University of Miami Hospital, Miami FL; 2Brandon Regional Hospital, Brandon FL; 3University of Nevada, Las Vegas, Las Vegas NV.
E-Mails: a.cano11@med.miami.edu; Daniel.Young@unlv.edu; HStamp@med.miami.edu; FJoaquin@med.miami.edu; JLopez13@med.miami.edu; LLupe@med.miami.edu; Stephanie.Moss2@hcahealthcare.com; d.anglade@miami.edu
Abstract:
Pressure Ulcers (PUs) in hospitalized patients are a high cost, high impact medical condition that is considered to be reasonably preventable through implementation of evidence-based prevention measures.   In the United States alone, (PUs) annually affect 1 to 2.5 million patients, at an estimated cost of $11 billion with a mortality of approximately 60,000 individuals.
There are multiple complications attributed to pressure ulcers, PU-associated sepsis is one of the most significant complications.  Studies have shown that for every 10,000 hospital discharges there are 3.5 cases of PU-associated sepsis.
This paper describes results of a comprehensive Pressure Ulcer Prevention Program (PUPP) implemented at a large academic medical center.  The success of this PUPP was likely tied to: 1) Implementation of Evidence-Based practice, 2) Evidence-Based product selection, 3) Clinician education.
Keywords: pressure ulcers; sepsis; Pressure Ulcer Prevention Program (PUPP); cost

Title: Nursing Interventions in the Prevention and cicatrization of ulcer Leg: Systematic Literature Review. Literature Review.
Authors:
César Fonseca 1, Manuel Lopes 2, Ana Ramos 3, Vitor Santos 4.
Affiliations:
1. RN, Ph.D. Candidate. Universidade de Évora, Portugal; 2. RN, Ph.D. Universidade de Évora; 3. RN, MSc, North Lisbon Hospital Center; 4. RN, MCs, West Hospital, IberWounds West
Abstract:
Objective: To identify the nursing interventions for people with leg ulcers of venous, arterial or mixed. Methodology: Carried out research in the EBSCO search engine: CINAHL Plus with Full Text, MEDLINE with Full Text, MedicLatina, Academic Search Complete, sought full text articles, published between 2008/01/01 and 2015/01/31, with the following keywords: [(MM "leg ulcer") OR (wound care) OR (wound healing)] AND [(nursing) OR (nursing assessment) OR (nursing intervention)], filtered through initial question in PI[C]O format.
Results: The different leg ulcer etiologies require a therapeutic and prophylactic specific approach. Factors were identified that promote healing: individualization of care, interpersonal relationship, pain management, control of exudate, education for self-management, self-care, therapeutic adherence, implementation of guidelines, audit and feedback from practices.
Conclusion: The person-centered care and evidence-based practice increases health outcomes in the prevention and treatment of leg ulcers.
Keywords: Leg ulcer; Nursing Interventions

Title: Tailoring the Implementation of International Pressure Ulcer Prevention Guidelines for Developing Countries: A Protocol
Authors: Rose Ekama Ilesanmi, Brigid M. Gillespie, Prisca Olabisi Adejumo, Wendy Chaboyer
Affiliations: University of Ibadan & Griffith University
E-Mails: b.gillespie@griffith.edu.au
Abstract: Background: The 2014 International Pressure Ulcer Prevention (PUP) Clinical Practice Guidelines (CPG) provide the most current evidence based strategies to prevent PU. The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context. Aim: To present a protocol detailing the tailoring of PUPCPG into a care bundle in the Nigerian context. Methods: Guided by the Knowledge to Action (KTA) framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. Results: PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in several Nigerian hospitals is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Conclusion: Using KTA, a knowledge translation framework to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.
Keywords:
pressure injury; care bundle; knowledge translation; less developed economies

Title: Magnifying Successful Outcomes using Evidence-based Research: Bolstering Student Learning while Accentuating Pressure Ulcer Care
Authors:
Melissa Kaufman
Affiliations:
Chatham University, Pittsburgh, PA, USA
E-Mails:
kaufman44m@gmail.com
Abstract:
Early identification and initiation of preventive measures for those at risk for developing pressure ulcers (PUs) is essential in the inpatient, outpatient, and home settings. Current research indicates that 10% of hospitalized patients have PUs, and the elderly are at the greatest risk. The increasing number of patients who are developing hospital-acquired pressure ulcers (HAPUs) is an added concern. When a HAPU develops, it affects the patient’s quality of life, prolongs hospitalization, and is costly to treat. High HAPU rates suggest poor quality care. While helping patients during clinical training, nursing students can play a pivotal role in PU prevention and in early HAPU identification. To facilitate this, nursing educators need to reinforce the initial didactic instruction that students receive on PUs throughout the semester. This paper describes reasons why HAPU rates need to decline. Educational methods for reinforcing student learning are provided. This paper concludes with a review of the literature reflecting how nursing students have positively impacted PU patient outcomes while bolstering their personal knowledge on skin care.
Keywords:
pressure ulcers, nursing students, hospital-acquired pressure ulcers, nursing education, simulation, nursing homes, evidence-based practice, quality care

Title: Chronic Wound Pain Management Transposing the Patient Experience
Authors: Eula Fahie-Romero
E-Mails: eulacf@aol.com
Abstract: Chronic wound pain is not a new concept. The management of chronic wound pain and its clinical significance continues to evolve. It challenges healthcare providers to gain an understanding of the physical, psychological and psychosocial impact on the patient‘s lived experience. Multiple scales, models and guidelines are established to guide the nurse or health caregiver in the management of chronic wound pain. The subjective sensation of chronic wound pain creates difficulty to always accurately measure the experience. It sets up a dominance which illicit a spiral of emotions; fear, anxiety, helplessness and loss of hope. A literature review was completed to define chronic wound pain, identify interventions, and associated emotions. Historical similarities of the patient with chronic wound pain show emotions remains unchanged. Changes have occurred with the recent concern for the patient experience, cost effective care and improved outcomes. Improvement with innovative products, and processes, can decrease or eliminate chronic wound pain. The goal is to gain and apply knowledge that connects with the patient experience to eliminate the impact of chronic wound pain. Further studies will be needed to examine ideas and concepts and close the gap in knowledge for chronic wound pain management.
Keywords:
pain; chronic wound pain; transpose

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