A prospective,open, multicentre study to evaluate a new gelling fibre dressing containing silver in the management of venous leg ulcers

This study investigated the performance of a new gelling fibre dressing containing silver (DURAFIBER? Ag; Smith & Nephew, Hull, UK) in moderate to highly exuding venous leg ulcers with one or more clinical signs of infection. Fourteen patients with venous leg ulceration of median ulcer duration 12·5 weeks, recruited from three centres in South Africa, received treatment with the new dressing for a maximum of 8 weeks. Multilayer compression bandaging was used for all patients, at the majority of assessments. The objectives of this study were to assess the clinical acceptability of the dressing in terms of the following characteristics: antimicrobial properties, the progress of the wound towards healing, wear time, exudate management, conformability, patient comfort, pain on application, pain on removal and dressing integrity. The new dressing was rated as clinically acceptable for all characteristics, for all 14 patients (100%). It was easy to apply and remove; in 96·8% of removals, the dressing stayed intact on removal and could be removed in one piece. Fifty per cent of the wounds healed within the 8‐week study duration; between baseline and final assessment, the median percentage reduction in wound area was 98·2% and the median percentage reduction in devitalised tissue was 78%. Exudate levels and wound pain were significantly improved at final assessment compared to baseline assessment, and an increase in the number of patients with healthy peri‐wound skin between baseline and final assessment was observed. A reduction in bioburden and signs of clinical infection and an improvement in quality of life were observed over the 8‐week period. The average wear time was 6·4 days. This study supports the use of new dressing in the management of moderately to highly exuding venous leg ulcers with clinical signs of infection.     

护理本科生临床实习期间压力程度和应对方式的相关因素研究

[目的]了解护理本科生临床实习期间的压力程度、应对方式，分析其相关因素，并探索压力程度与应对方式的相关性。[方法]采用问卷调查法，在临床实习前期对80名护理本科生进行调查。[结果]护生的压力程度以中度为主，应对方式较积极。对压力程度有影响的因素：父母职业、家庭子女数和护生类别；对应对方式有影响的因素：专业态度和相关社会实践；积极应对方式与压力程度呈负相关，消极应对方式与压力程度呈正相关。[结论]护理本科生压力程度与父母职业、家庭子女数及护生类别有关，应对方式受专业喜好程度及社会实践经验影响。护理教师应针对性地为护生提供指导和帮助，减轻临床实习期闻的压力．提高实习效果。     

Treatment of corneal chemical alkali burns with a crosslinked thiolated hyaluronic acid film

Purpose

The study objective was to test the utilization of a crosslinked, thiolated hyaluronic acid (CMHA-S) film for treating corneal chemical burns.

Efficacy of Hyperbaric Oxygen Therapy in Diabetic Foot Ulcers Based on Wagner Classification

Diabetic foot ulcer is a common chronic complication of diabetes mellitus. In addition to conventional primary therapy, there are adjuvant therapy methods such as hyperbaric oxygen therapy for the healing of diabetic foot ulcer wounds. The present study aimed to determine the efficacy of hyperbaric oxygen therapy in diabetic foot ulcers based on Wagner classification. It was performed retrospectively from prospectively collected data. One hundred thirty patients with diabetic foot ulcers were assessed in 2 groups: 1 group received hyperbaric oxygen therapy; the other group did not. Patients were examined according to age, sex, ulcer grade based on Wagner classification; ulcer healing status; whether hyperbaric oxygen therapy was received; duration of diabetes in years; HbA1C, sedimentation, C-reactive protein levels; and presence of accompanying diseases, including peripheral arterial disease, chronic obstructive pulmonary disease, hypertension, chronic kidney disease, neuropathy, and retinopathy. The mean follow-up period was 19.5?±?4.45 months (range 12 to 28 months). Seventy-one (54.6%) patients received hyperbaric oxygen therapy, and 59 (45.4%) patients did not. All patients in Wagner grade 2 healed in both groups. In the group that received hyperbaric oxygen therapy for grade 3 and 4 patients, 35 (87.5%) and 11 (84.6%) healed, respectively. In total, 60 (84.5%) patients in the group that received hyperbaric oxygen therapy healed. The subgroup comparison conducted according to Wagner classification revealed no differences between the 2 groups of grades 2 and 5 patients. It also revealed that treatment had higher levels of efficacy in the healing of ulcers in grade 3 and 4 patients.     

Copious Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Complicated Appendicitis in Adults

Objective: The objective of this study was to determine whether copious irrigation of peritoneal cavity during laparoscopic appendectomy for complicated appendicitis effectively reduces the incidence of postoperative complications and improves the postoperative recovery in adults compared with suction alone. Methods: In this prospective randomized trial, adult patients with complicated appendicitis were randomized to “irrigation and suction”(IS) group or “suction only”(SO) group. All surgery was performed with a standardized 3-port laparoscopic approach. The IS group received peritoneal irrigation with a minimum of 2000 mL sterile normal saline. The study primary outcomes included wound infection and postoperative intra-abdominal abscess. The study secondary outcomes included duration of operation, first anal exsufflation time, duration of hospital stay and hospital charges. Chi-squared and t-tests were used to analyze the study data. Results: Between January 2015 and June 2016, a total of 260 patients with complicated appendicitis were enrolled in the study. The peritoneal irrigation resulted in a longer operation time (51.6 ± 16.1 vs. 41.5 ± 15.2 min, p <0.001). There was no significant difference in the rate of wound infection between the two groups. However, the patients who received irrigation had a lower postoperative intra-abdominal abscess rate (3.1% vs. 9.2%, p = 0.039), earlier anal exsufflation (25.2 ± 16.5 vs. 30.7 ± 18.1 hr, p = 0.011), shorter hospital stay (10.2 ± 2.5 vs. 12.5 ± 2.8 days, p <0.001) and lower hospital charges (¥14,592 ± 2,251 vs. 16,674 ± 2,163, p <0.001) compared to those received suction alone. Conclusions: The study findings revealed that copious irrigation of peritoneal cavity during laparoscopic appendectomy could decrease the incidence of postoperative intra-abdominal abscess in adult patients with complicated appendicitis. These patients also had faster postoperative recovery and lower hospital charges.     

临床护理路径对髋关节置换术患者的影响

目的探讨临床护理路径对髋关节置换术患者的影响。方法随机将136例行髋关节置换术患者分为研究组和对照组各68例。对观察组患者实施临床护理路径,对对照组患者采用按常规医嘱进行护理,采用随机教育方式给予护理指导。结果观察组患者并发症(尿潴留、下肢静脉血栓)、入睡困难者明显少于对照组,经χ2检验p值均<0.01,差异有显著性;观察组伤口疼痛、腰背疼痛、焦虑得分、平均住院日均少于对照组,观察组病人满意度明显高于对照组,经t检验p值均<0.01,差异有显著性。结论实施护理路径能够减少病人的并发症,增加病人的舒适度,减轻病人的焦虑,有效缩短病人住院天数,促进病人早日康复,同时促进了护患沟通,提高了患者对护理工作的满意度,获得良好的护理效果。     

Development and ultra‐structure of an ultra‐thin silicone epidermis of bioengineered alternative tissue

Burn wound care today has a primary objective of temporary or permanent wound closure. Commercially available engineered alternative tissues have become a valuable adjunct to the treatment of burn injuries. Their constituents can be biological, alloplastic or a combination of both. Here the authors describe the aspects of the development of a siloxane epidermis for a collagen‐glycosaminoglycan and for nylon‐based artificial skin replacement products. A method to fabricate an ultra‐thin epidermal equivalent is described. Pores, to allow the escape of wound exudate, were punched and a tri‐filament nylon mesh or collagen scaffold was imbedded and silicone polymerisation followed at 120°C for 5 minutes. The ultra‐structure of these bilaminates was assessed through scanning electron microscopy. An ultra‐thin biomedical grade siloxane film was reliably created through precision coating on a pre‐treated polyethylene terephthalate carrier.     

Ten years of experience in chronic ulcers and malignant transformation

Malignant degeneration of wounds is rare and often misdiagnosed. Delay in diagnosis may result in a worse prognosis. The aim of this study is to determine the number of skin cancers associated with chronic skin ulcers in our facility over a period of 10 years. Between January 2002 and December 2012, a total of about 1000 patients had consulted with us for chronic wounds, especially of vascular, diabetic and traumatic origin and pressure ulcers. Thirteen skin cancers had been detected: seven squamous cell and five basal cell carcinomas and one melanoma. We highlight how important it is to be aware of the signs suggesting a malignant change and the importance of biopsy at regular intervals during the life cycle of any chronic wound.