Patient perception of osteopathic training in the UK and patient reported experience

BackgroundOsteopathy is a recent addition to the modern day healthcare community. The majority of patients attending osteopathic practices in the United Kingdom are self funders, and studies have reported a high rate of satisfaction in patients receiving osteopathic treatment.ObjectiveThis study aimed to determine patient perception of osteopathic education and relate that to patient reported experience.MethodThe study was conducted through newspapers, GP surgeries and osteopathic clinics. A questionnaire was either completed on-line or a paper copy was returned to the investigator.ResultsOver seven hundred people respondent though for this part of the study 202 were excluded either because they reported both good and bad experiences or did not complete the section on osteopathic education. Similar to other studies this current study reported that the majority of respondents reported a good experience (88.7%). However, there was no statistical significance demonstrated for any of the patient demographics or for the respondents perception of osteopathic education and experience.Discussion and conclusionFurther work is required to assess what patients require for a ‘good’ experience and what osteopathic patients determine as key competencies required in an osteopath.     

Validation of a laser‐assisted wound measurement device in a wound healing model

In the treatment and monitoring of a diabetic or chronic wound, accurate and repeatable measurement of the wound provides indispensable data for the patient's medical record. This study aims to measure the accuracy of the laser‐assisted wound measurement (LAWM) device against traditional methods in the measurement of area, depth and volume. We measured four ‘healing’ wounds in a Play‐Doh^®‐based model over five subsequent states of wound healing progression in which the model was irregularly filled in to replicate the healing process. We evaluated the LAWM device against traditional methods including digital photograph assessment with National Institutes of Health ImageJ software, measurements of depth with a ruler and weight‐to‐volume assessment with dental paste. Statistical analyses included analysis of variance (ANOVA) and paired t‐tests. We demonstrate that there are significantly different and nearly statistically significant differences between traditional ruler depth measurement and LAWM device measurement, but there are no statistically significant differences in area measurement. Volume measurements were found to be significantly different in two of the wounds. Rate of percentage change was analysed for volume and depth in the wound healing model, and the LAWM device was not significantly different than the traditional measurement technique. While occasionally inaccurate in its absolute measurement, the LAWM device is a useful tool in the clinician's arsenal as it reliably measures rate of percentage change in depth and volume and offers a potentially aseptic alternative to traditional measurement techniques.     

Plastic wound protectors do not affect wound infection rates following laparoscopic-assisted colectomy

Background: Wound protectors are plastic sheaths that can be used to line a wound during surgery. Wound protectors can facilitate retraction of an incision without the need for other mechanical retractors and have been proposed as deterrents to wound infection. The purpose of this study was to define the ability of wound protectors to reduce the rate of infection when used in laparoscopic-assisted colectomy. Methods: We completed a retrospective review of the medical records of patients undergoing nonemergent laparoscopic-assisted colectomy between February 1999 and November 2002. All completely laparoscopic cases were excluded. The wound protector, when used, was applied to the extraction incision during the externalized portion of the procedure (colon and mesentery transection, anastomosis). Outcomes for patients with and without the use of a wound protector were compared. Results: A total of 141 patients underwent laparoscopic-assisted colectomy (98 for benign/malignant tumors, 35 for diverticular disease, and eight for Crohns disease). There were no differences between the wound protector group (n = 84) and the no wound protector group (n = 57) with respect to mean age (55 vs 58 years), average body mass index (27 vs 29 kg/m²), gender, indication for surgery, comorbidities, antibiotics used, or mean operative time (185 vs 173 min). Nine patients in the wound protector group and eight in the no wound protector group developed a wound infection at the colon extraction site (p = 0.42). Patients undergoing resection for Crohns disease or diverticulitis had a higher infection rate (18.6%) than patients undergoing resection for polyps or cancer (9.2%; p < 0.05). No wound recurrence of cancer was observed in either group at a mean follow-up of 23 months (range, 3–48). Conclusions: The wound protector, although useful for mechanical retraction of small wounds, does not significantly diminish the rate of wound infection at the bowel resection/anastomotic site. Patients undergoing elective resection for inflammatory processes have higher infection rates than patients undergoing laparoscopic-assisted colectomy for polyps or cancer.     

Patient Perception after Traumatic Brachial Plexus Injury – A Qualitative Case Report

Study designThis is a qualitative case study.IntroductionConsidering individual patient's perception is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002).Purpose of StudyThe report highlights the importance of patient education and considering individual's perception to achieve rehabilitation outcomes.MethodA written informed consent for case report was given by a 24-year-old male, a mass media graduate student diagnosed with global brachial plexus injury. Detailed evaluation by a senior therapist was conducted in a tertiary government hospital using the following tools:

创面治疗中心建设的实践

The construction of wound healing or wound care center in China is necessary for patients and about 10 wound healing or care centers have already been established during the past years. In this paper, we summarize their experience and expect their development in the future.     

Telemedicine in wound healing

Better care for patients and improved health care depends on the availability of good information which is accessible when and where it is needed. The development of technology, more specifically the Internet, has expanded the means whereby information can be acquired and transmitted over large distances enabling the concept of telemedicine to become a reality. Telemedicine, defined as the practise of medicine at a distance, encompasses diagnosis, education and treatment. It is a technology that many thought would expand rapidly and change the face of medicine. However, this has not happened and during the last decade although certain telemedicine applications, such as video-consulting and teleradiology, have matured to become essential health care services in some countries, others, such as telepathology, remain the subject of intensive research effort. Telemedicine can be used in almost any medical specialty although the specialties best suited are those with a high visual component. Wound healing and wound management is thus a prime candidate for telemedicine. Development of a suitable telemedical system in this field could have a significant effect on wound care in the community, tertiary referral patterns and hospital admission rates.     

加强创面修复专科的内涵建设

Following the development of social economy,the acceleration of aging problem,and the changes in disease spectrum,the incidence of various chronic wound diseases increased significantly,and it has beco...     

Surface area estimation for application of wound care

Estimation of surface for application of wound care is one of the important prognostic factors for wound healing. The objective of this study is to measure a surface area estimation for application of wound care. Non-invasive, 3D surface reconstruction methodology using two monocular cameras was implemented and verified. The measurement environment was setup on 10 patients with different kind of wounds. Phantom measurements, with known dimensions, show accuracy of implemented method below 11 percent The patient’s measurements has the same accuracy. The implemented method use state of art algorithms and the cheap equipment and can be treated as an auxiliary, more objective method to quantify the wound healing process.     

The influence of different sizes and types of wound fillers on wound contraction and tissue pressure during negative pressure wound therapy

Negative pressure wound therapy (NPWT) contracts the wound and alters the pressure in the tissue of the wound edge, which accelerates wound healing. The aim of this study was to examine the effect of the type (foam or gauze) and size (small or large) of wound filler for NPWT on wound contraction and tissue pressure. Negative pressures between --20 and --160 mmHg were applied to a peripheral porcine wound (n = 8). The pressure in the wound edge tissue was measured at distances of 0·1, 0·5, 1·0 and 2·0 cm from the wound edge and the wound diameter was determined. At 0·1 cm from the wound edge, the tissue pressure decreased when NPWT was applied, whereas at 0·5 cm it increased. Tissue pressure was not affected at 1·0 or 2·0 cm from the wound edge. The tissue pressure, at 0·5 cm from the wound edge, was greater when using a small foam than when using than a large foam. Wound contraction was greater when using a small foam than when using a large foam during NPWT. Gauze resulted in an intermediate wound contraction that was not affected by the size of the gauze filler. The use of a small foam to fill the wound causes considerable wound contraction and may thus be used when maximal mechanical stress and granulation tissue formation are desirable. Gauze or large amounts of foam result in less wound contraction which may be beneficial, for example when NPWT causes pain to the patient.     

Identifying wound prevalence using the Mobile Wound Care program

Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC?) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers.     

The role of hyaluronan in wound healing

The polysaccharide hyaluronan (HA) (synonyms – hyaluronic acid, hyaluronate) is a versatile, polymorphic, glycosoaminoglycan with vast biological functions. HA is found throughout the body, primarily residing in skin, thus playing an important role in wound healing. Research regarding HA's function has changed over the years, primarily focussing on a particular aspect or function. The contribution of HA in each stage of normal wound healing as well as its clinical wound dressing applications will be examined.     

Pilot study to evaluate a novel three‐dimensional wound measurement device

As the burden of diabetes continues to grow and treatment standards require careful tracking of wound progress, clinicians increasingly need to rely on technological improvements in wound measurement technologies to track the progress of their treatments. This study aims to determine the accuracy of a new three‐dimensional wound measurement (3DWM) device against laser‐assisted wound measurement (LAWM) devices and traditional methods of wound measurement. Using several wound models, we demonstrate that the 3DWM device measures wound area, depth and volume similarly to the other methods tested. This is especially apparent when changes in wound measurements were compared between the two devices. Differences between the two technologies were apparent when analysing wound measurement time and measurement repeatability. There was a significantly lower incidence of error in measurements between the 3DWM device and the LAWM device. Finally, the measurement time was significantly faster with the 3DWM device compared to the LAWM device. Together, these data demonstrate that the 3DWM device provides an accurate and reproducible method for measuring changes in wound healing similar to other available technologies. Further, the use of the 3DWM device provides a faster and more consistent measurement, which is critical for clinical application and use.     

Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study

It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we determined which patient‐ and wound‐related characteristics best predict time to complete wound healing and derived a prediction formula to estimate how long this may take. We selected 563 patients with acute wounds, documented in the WEC registry between 2007 and 2012. Wounds had existed for a median of 19 days (range 6–46 days). The majority of these were located on the leg (52%). Five significant independent predictors of prolonged wound healing were identified: wound location on the trunk [hazard ratio (HR) 0·565, 95% confidence interval (CI) 0·405–0·788; P = 0·001], wound infection (HR 0·728, 95% CI 0·534–0·991; P = 0·044), wound size (HR 0·993, 95% CI 0·988–0·997; P = 0·001), wound duration (HR 0·998, 95% CI 0·996–0·999; P = 0·005) and patient's age (HR 1·009, 95% CI 1·001–1·018; P = 0·020), but not diabetes. Awareness of the five factors predicting the healing of complex acute wounds, particularly wound infection and location on the trunk, may help caregivers to predict wound healing time and to detect, refer and focus on patients who need additional attention.     

骨桥蛋白促创面愈合的实验研究

目的　探讨骨桥蛋白 (OPN)在创面愈合中的作用和意义 ,为筛选促进伤口愈合的外用药物提供实验依据和理论基础。方法　建立创伤实验性模型 ,将其分为OPN组、血清组、EGF组。采用免疫组织化学染色 ,Westernblot分析等方法检测Ⅰ型胶原和羟脯氨酸含量。结果　 (1)形态学改变 :术后第 1天 ,OPN组创面可见有少量的渗出物。术后第 2～ 3天 ,血清组虽有肉芽组织增生 ,但没有充满伤口底层 ;而OPN组、EGF组的创面肉芽组织增生明显。术后第 4～ 7天 ,OPN组肉芽组织层明显较血清组、EGF组薄。 (2 )免疫组织化学染色显示 ,术后第 7天 ,在OPN处理的肉芽组织中Ⅰ型胶原含量略少于EGF组 ,但比血清组高 ,其Westernblot结果与免疫组织化学基本一致。 (3 )羟脯氨酸含量 :各实验组肉芽组织中羟脯氨酸含量差异无显著性 (P >0 .0 5 )。结论　OPN是一种促炎因子 ,具有诱导创伤早期炎症反应的和愈合后期抑制肉芽组织过度增生的功能。     

负压技术用于伤口治疗的现状

Negative-pressure wound therapy (NPWT)has been used to help wound healing since early 1970s, and it has been used increasingly for treating a wide variety of wounds since the early 1990s and started to popularize in China near the mid 1990s. This technique is different from conventional dressing change, as it controls local humidity, alleviates edema, and improves local circulation all by negative pressure. The method generally involves the application of a dressing on the wound surface, connecting the dressing to a vacuum pump through a tube,and then sealing the wound with adhesive films. Most of the clinicians in China believe that NPWT is helpful in accelerating wound healing, though as yet there is no strong evidence to support it. Therefore, it is necessary to conduct more research to further clarify the mechanism and therapeutic effect of NPWT.     

人唾液对创面愈合影响的实验研究

目的通过与云南白药比较,观察人唾液对创面愈合的作用,以期初步阐明作用机制。方法 3月龄雄性日本大耳白兔6只,体重2.0～2.5 kg;于每只兔脊柱两侧制备深至皮下、大小为2.5 cm×2.5 cm的创面6个。根据处理方法不同,将36个创面随机分为3组(n=12):空白对照组每天涂抹0.4 mL生理盐水;云南白药组每天涂抹0.5 g云南白药粉,唾液组每天涂抹0.4 mL人唾液,连续15 d。观察创面愈合情况,伤后3、5、8、11、15 d测量创面面积,计算创面愈合率;伤后15 d处死动物取创面组织行组织学观察,计数炎性细胞及微血管密度。结果唾液组和云南白药组创面愈合速度明显快于空白对照组,渗液量少,结痂快。伤后5、8、11 d,唾液组创面愈合率均显著高于空白对照组及云南白药组,差异有统计学意义(P<0.05)。组织学观察显示术后15 d,唾液组创面未见明显出血、坏死,创面基本由表皮覆盖,再生表皮向创面中心覆盖生长,唾液组炎性细胞计数及微血管密度均显著低于云南白药组及空白对照组,差异有统计学意义(P<0.05)。结论唾液可明显促进创面愈合,作用机制可能与其减少炎性细胞浸润、防止伤口感染、加速胶原纤维增生及促进创面血管重建有关。     

Comparison of bacteria-retaining ability of absorbent wound dressings

Fibrous materials in some modern absorbent wound dressings have the ability to sequester and retain bacteria; however, this ability varies according to the nature of the fibres. We studied the bacterial retention capacity of alginate and carboxymethylcellulose dressings, using an infected skin ulcer model on the backs of rats. Wound surfaces were inoculated with either Staphylococcus aureus or Pseudomonas aeruginosa at a concentration of 1.5 x 10(6) colony-forming units per wound. AQUACEL; Hydrofiber;, Kaltostat; or Sorbsan; were applied to the contaminated wounds for 12 h. Each dressing was then divided into two pieces. Total viable bacterial count within the dressing was calculated using one piece, and bacterial count released from the dressing into physiological saline was determined using the other piece, enabling bacterial retention rate to be calculated. Bacterial counts in tissue were also determined. Each dressing was tested on each of 10 wounds contaminated with each bacterium. Statistical analyses were performed using one-way analysis of variance (ANOVA) for replicated measures combined with Duncan's multiple comparison test. AQUACEL; Hydrofiber; dressing was most effective in its ability to retain both Staphylococcus aureus and Pseudomonas aeruginosa (p < 0.05). Bacterial counts in tissue showed no significant change with respect to pathogen or the type of dressing used. It can be concluded that the bacterial retaining ability of AQUACEL; Hydrofiber; dressing was found to be significantly higher than that of alginate dressings in an infected animal wound model.     

Effects of immunosuppressive therapy on wound healing

Immunosuppressive therapy is increasingly being used in clinical practice and has been shown to affect wound healing to varying degrees. This article looks at the effects of the newer immunosuppressive agents on wound healing. It is shown that wound healing is impaired via different mechanisms. Some of the animal and human studies are reviewed in more detail. It is shown that some of the newer agents affect wound healing to such an extent that reduction or avoidance of these drugs until complete wound healing is achieved is advocated. More research is required for these newer agents to determine the most appropriate time to introduce them.     

The fluid dynamics of simultaneous irrigation with negative pressure wound therapy

Saline irrigation has been shown to be both experimentally and clinically efficacious in decreasing bacterial contamination as well as decreasing infection rates. The dynamics of irrigation delivery fall into two primary categories: simultaneous and intermittent irrigation. An important component to irrigation therapy is distribution of irrigation solution to hard‐to‐reach areas of a wound bed, including undermining and fissure‐like structures. Here we test the effectiveness of simultaneous irrigation to fill the irregular structures of a wound bed. In order to visualise the dynamic movement of irrigation solution, three‐dimensional wound models were constructed using clear synthetic ballistic gel. Wounds with the aforementioned characteristics were carved into the ballistic gel with varying area, depth and volume. All three wounds were dressed as per manufacturer's instructions. Data demonstrate that simultaneous irrigation is effective in reaching all parts of a wound bed in wound models that have both undermining and tunnelling, and irrigation effectively saturates bridged wounds. Finally, this study shows that there is constant turnover of irrigation solution in the wound that is driven more by administration volume and less by flow rate. These data show that simultaneous irrigation is an effective technique for delivering irrigation solution to both simple and complex wounds.