Cover Page and Contents
AWMA, through Wound Practice and Research (WPR) is keen for readers to be aware of similar high quality journals. Below details the current cover page and contents of the latest issue of the Journal of Wound Care.
Volume: 19 |
Issue: 7 |
Release: July 2010
|
Contents - Journal of Wound Care 19(7): Jul 2010
Bringing evidence closer to home (53kb)
As you can see, the evidence debate is being pursued once again in the pages of this journal (see page 282 for the commentaries on the EWMA Patient Outcome Group document, published in JWC last month). I am not going to outline the issues once more, as we all know the perspectives of each side of the argument. But where does it leave the generalist or novice practitioner, who wants guidance on how to improve their practice but is not necessarily confident about critiquing research papers, or even knows where to look? Should they rely on systematic review evidence - like those that have stated that there is little data to support the use of silver dressings and topical negative pressure - or place greater trust in clinical trials and, even, the everyday reality that often shows the above therapies having the required effect?
Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics (159kb)
Objective: To compare healing outcomes at a wound healing centre both before and after the
introduction of molecular pathogen diagnostics. Method: An IT consultant was recruited to analyse the medical records of patients at a wound healing centre, comparing patient groups from 2007 and 2009 - before and after the introduction of comprehensive molecular pathogen diagnostic methods. Results: Before the implementation of molecular diagnostics, 244/503 patients (48.5%) healed completely, while after implementation 298/479 patients (62.4%) healed. Furthermore, based on survival analysis and after controlling for potential confounding factors, time to healing was signifi cantly shorter in 2009 than 2007 (p<0.05). Specifi cally, biofi lm-based wound care, along with the implementation of comprehensive molecular diagnostics for venous leg ulcers, pressure ulcers and diabetic foot ulcers and all wounds combined showed, respectively, 21%, 23%, 25% and 22% reductions in the time to healing. In addition, after implementing molecular diagnostics, the use of expensive fi rst-line antibiotics also declined in 2009, while a broader range of targeted antibiotics was used. Conclusion: The results of modern molecular pathogen diagnostic applications allow comprehensive evaluation of the microbial bioburden in chronic wounds. This comprehensive diagnostic in turn has led to a more precise and targeted therapeutic approach to wound care. With the comprehensive nature of
molecular diagnostics future advances in topical patient specifi c therapeutics are now possible.
- R.D. Wolcott, S.B. Cox, S.E. Dowd
Journal of Wound Care 19(7): 276 - 284 (Jul 2010)
- view article
Reflections on the recommendations of the EWMA Patient Outcome Group document (61kb)
Last month, JWC published recommendations on improving the quality of evidence in wound management. In response, the Wounds Research Group from the University of York and Richard White, Professor of Tissue Viability, outline their very different perspectives on the type of evidence needed in tissue viability
- R. Ashby, J.M. Bland, N. Cullum, J. Dumville, J. Hall, A. Kang’ombe, M. Madden, S. O’Meara, M. Soares, D. Torgerson, J. Watson
Journal of Wound Care 19(7): 282 - 285 (Jul 2010)
- view article
A possible animal model for critical colonisation (596kb)
Objective: To develop a critical colonisation model in rats that will facilitate investigation of its
pathophysiology and the development of new and effective diagnosis and treatment protocols.
Method: Three groups of rats were given full-thickness dorsal wounds: a control group received
phosphate-buffered saline; an experimental group was inoculated with Pseudomonas aeruginosa; an infection group with streptozotocin-induced diabetes was also inoculated with P. aeruginosa. All groups were assessed on a number of parameters at days 1, 3, 5 and 7 following wounding. Parameters included gross observations, histopathological observations, quantifi cation of redness and swelling, serum C-reactive protein (CRP) measurement and tissue bacterial counts. Results: Healing was delayed in the experimental group when compared with the control group, with no signs of infl ammation. Although the numbers of bacteria were similar in the experimental and infection groups, polymorphonuclear neutrophil (PMN) infi ltration was localised to granulation tissue in the experimental group, whereas it extended to muscular tissue in the experimental group. CRP levels remained low in the experimental group.
Conclusion: These findings suggest that the inoculation of bacteria provides a possible model of
critical colonisation in rats. We believe this will contribute to a better understanding of critical
colonisation.
- K. Ueda, T. Akase, G. Nakagami, T. Nagase, T. Minematsu, L. Huang, H. Sagara, Y. Ohta, H. Sanada
Journal of Wound Care 19(7): 285 - 290 (Jul 2010)
- view article
Clinical experience with an antimicrobial hydrogel dressing on recalcitrant wounds (67kb)
Objective: To assess the performance of a newly-introduced, iodine-based antimicrobial wound
dressing (Iodozyme) within normal clinical practice. Method: 51 case records were collected from 30 wound care locations in England. Reporting clinicians used Iodozyme on one or more diffi cult wounds of their own choice (of various aetiologies) from their current case loads. Basic patient-specifi c data were collected, relating to both their own and their patients' experience with the product over a 6-week period of treatment (or less, if healing was achieved earlier). In every case, the wound continued to be treated in accordance with local 'best practice', in accordance with the manufacturer's instructions and by the same clinician. Each wound was
assessed in terms of size, condition (margins and wound bed), exudate (type and amount), comfort/pain, overall satisfaction (by patient and clinician) and healing status (in terms of healed, improved, static or deteriorated). In addition, clinicians were asked to use their own local criteria and parameters where possible, with general guidance as and when it was needed.
Results: The mean duration of all wounds was 25.8 months (median 13 and range 1-312). Nine
patients had a wound of less than six months' duration, and 17 had one of two years' or more duration. Within the 6-week study period, 6 wounds healed fully, 37 were judged to have improved, 7 remained static and 1 deteriorated. Overall, the majority of clinicians and patients were 'satisfied' or 'very satisfied' with product performance and 77% of clinicians concluded that the dressing was 'better' or 'much better' than other dressings they had previously used on similar wounds. Conclusion: While we cannot generalise from this study, the encouraging clinical results and positive patient and clinician feedback lead us to believe that Iodozyme is a dressing worthy of consideration when treating chronic wounds. These encouraging preliminary findings are now to be followed up with a randomised control trial.
- L. Wood, Z. Wood, P. Davis, J. Wilkins
Journal of Wound Care 19(7): 298 - 303 (Jul 2010)
- view article
International organisations update (60kb)
Australian Wound Management Association (AWMA)
Danish Wound Healing Society (SAAR)
European Pressure Ulcer Advisory Panel (EPUAP)
European Tissue Repair Society (ETRS)
European Wound Management Association (EWMA)
Wound Management Association of Ireland (WMAI)
Associazione Italiana Ulcere Cutenee onlus (AIUC) (Italian Association for Cutaneous Ulcers)
Wound Healing Association of Southern Africa (WHASA)
Spanish Society for Pressure Ulcers (GNEAUPP)
Swedish Society for Tissue Viability Nurses (SSiS)
Taiwan Wound, Ostomy and Continence Nurses Association (TWOCNA)
Tissue Viability Society (TVS)
National Pressure Ulcer Advisory Panel (NPUAP)
Wound Healing Society (WHS)
Wound Ostomy and Continence Nursing Society (WOCN)
Resistance carrying plasmid in a traumatic wound (101kb)
Objective: To isolate and identify antibiotic-resistant bacteria from the exudate of a complex wound and determine if antibiotic resistance genes are chromosomal or plasmid borne. Method: Antibiotic resistant bacteria from wound exudate of a single clinical sample were selected on agar media with ampicillin. A single colony was further screened for resistance to kanamycin by antibiotic-supplemented agar and to other antibiotics by an automated Phoenix instrument.
Identifi cation of the isolate was carried out by biochemical profiling and by 16S rDNA analysis.
Results: Approximately 51% of total bacteria in the wound exudate with identical colony morphotype were resistant to 100ug/ml of ampicillin. A single colony from this population also demonstrated resistance to 50ug/ml of kanamycin on kanamycin-supplemented agar. Further antimicrobial sensitivity testing by the Phoenix instrument indicated resistance to inhibitory concentrations of amoxicillinclavulanate, ampicillin-sulbactam, cefazolin, gentamicin, nitrofurantoin, tobramycin, and trimethoprimsulfamethoxazole. Biochemical and 16S rDNA analysis identifi ed this bacterial isolate as a member of genus Enterobacter. A plasmid preparation from this isolate successfully transferred ampicillin and kanamycin resistance to E. coli competent cells. E. coli transformants displayed two resistance phenotypes and the plasmids from these transformants displayed two different restriction type patterns, with one correlating to ampicillin and kanamycin resistance and the other only to ampicillin resistance.
Conclusion: A multiple antibiotic-resistant Enterobacter spp. from the wound fluid of a clinical sample was found to carry an antibiotic-resistant plasmid in a closely related species E. coli. The presence of antibiotic resistance plasmid in Enterobacteria that are part of the normal microbial flora of the human gut and skin could lead to the spread of resistance phenotype and emergence of antibiotic resistant pathogens. This study suggests normal human microbial fl ora could be a potential reservoir for resistance genes.
- M.R. Alavi, A. Ravizee, R. Burgess, V. Antonic, M. Izadjoo, A. Stojadinovic
Journal of Wound Care 19(7): 306 - 310 (Jul 2010)
- view article
Effect of an arginine-containing nutritional supplement on pressure ulcer healing in community spinal patients (137kb)
Objective: To determine whether or not the use of an arginine-containing nutritional supplement could result in signifi cantly shorter pressure ulcer (PU) healing times in people with spinal cord injuries living in the community, compared with a comparative historical control group. Method: Eighteen spinal-cord-injured patients (all part of a hospital spinal outreach service) received 9g of a commercial powdered arginine supplement per day until full PU healing occurred. Healing rates were compared against 17 historical control patients (as assessed by medical history audit). Results: Baseline characteristics (age, gender, injury level and time) were similar between groups. Mean ulcer healing times were 10.5 ± 1.3 weeks versus 21 ± 3.7 weeks (p<0.05) in the intervention and control groups respectively. Comparison of healing rates in the intervention group against expected healing rates derived from the medical literature showed that intervention patients had a signifi cantly shorter mean healing time (category 2 PU: 5.5±1.3 weeks versus 13.4 weeks; category 3 PU: 12.5 ± 1.9 weeks versus 18.2 weeks; category 4 PU: 14.4 ± 4.8 weeks versus 22.1 weeks). A diagnosis of diabetes did not significantly alter healing rates in either group. Conclusion: Results from this observational study show a promising benefit of arginine supplementation on PU healing for individuals with spinal cord injury living in the community.
- S. Brewer, K. Desneves, L. Pearce, K. Mills, L. Dunn, D. Brown, T. Crowe
Journal of Wound Care 19(7): 311 - 316 (Jul 2010)
- view article
