Aim: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES)... more Aim: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). Design: Prospective psychometric instrument validation study. Method: OASES was developed based on a literature review and expert input (n=19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. Results: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI=0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01 and 0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p<0.001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI=0.78-0.86) for the full instrument, and varied between 0.72 (95% CI=0.64-0.79) and 0.85 (95% CI=0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. Conclusion: OASES is supported by acceptable psychometric properties and can be applied in nursing education, research and practice to assess knowledge of healthcare professionals about skin tears. Impact: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice and research needs and priorities related to skin tears in clinical practice.
Research is limited on how nurses in community settings manage ethical conflicts. To address this... more Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty (“Should I be addressing what I think is a moral problem?”). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.
66 l Nursing2019 l Volume 49, Number 4 www.Nursing2019.com S KIN TEARS have historically been unr... more 66 l Nursing2019 l Volume 49, Number 4 www.Nursing2019.com S KIN TEARS have historically been unrecognized by patients and caregivers in most circumstances, but they can become chronic and difficult to manage when left untreated.1,2 As the skin becomes drier, less elastic, and more vulnerable as one ages, skin tears become more common, particularly in older adults.1,2 This article reviews the prevalence, prevention, assessment, and management of skin tears with the goal of reducing misdiagnosis and promoting evidence-based management.
Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chron... more Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chronic health condition often associated with a prolonged healing trajectory and frequent recurrence. It is estimated that approximately 1.5 to 3.0 per 1,000 adults have active leg ulcers, and the prevalence continues to increase due to an aging population. Management of chronic edema using compression is crucial to promote healing of venous leg ulcers. The principle of compression therapy is simple, involving the use of external pressure in the forms of bandages or wraps to move the fluid from the interstitial space back into the intravascular compartment and prevent reflux. This article synthesizes and appraises the evidence for various types of compression therapies. It also addresses best practice recommendations for the management of leg ulcers when arterial circulation is considered suboptimal.
To provide the practitioner with current information on the most common nail disorders. This cont... more To provide the practitioner with current information on the most common nail disorders. This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders. After reading this article and taking this test, the reader should be able to: 1. Describe the structures that compose the nail apparatus. 2. Identify the most common nail disorders, including etiology and treatment.
Background The older adult population in Canada is increasing, and many will require care within ... more Background The older adult population in Canada is increasing, and many will require care within an acute geriatric unit (AGU) or long-term care facility (LTCF). However, the nursing workforce is not growing at the same pace as the population is aging. New graduate nurses may be able to fill this gap; therefore, it is important to understand their intentions of working in gerontological care settings (i.e., AGU or LTCF). Aim To examine if nursing education and personal attitudes toward older adults influence newly registered nurses’(RNs) intentions to work in a gerontological care setting. Method Nurses (n= 1,103) who registered with the College of Nurses of Ontario for the first time in 2018 were invited to complete a questionnaire. Results The majority of participants (n = 181) reported a positive attitude toward older adults. However, only 14% reported an intention to work in a gerontological care setting. Participants who completed multiple geriatric focused clinical placements ...
Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture... more Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from ...
The aim of this study was to summarise the clinical evidence supporting almost 40 years of topica... more The aim of this study was to summarise the clinical evidence supporting almost 40 years of topical cadexomer iodine (CIOD) use in wound bed preparation by removing barriers to healing such as exudate, slough, bioburden, and infection and allowing chronic wound progression. A systematic review was conducted (Embase/PubMed, November 2020) to identify relevant compara-K E Y W O R D S cadexomer iodine, desloughing, exudate, infection, wound healing Kevin Woo and Caroline Dowsett are co-first authors.
Background: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private fo... more Background: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods: A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results: The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate use of PU prevention materials, the empowering of staff to improve the quality of PU care, and improved home management. Conclusion: Through the action research approach, the care staff were empowered and their PU prevention care practices had improved, which contributed to the decreased incidence of pressure ulcers. A PU prevention protocol that was accepted by the staff was finally developed as the standard of care for such homes.
International journal of emergency medicine, Jan 27, 2010
As millions of emergency department (ED) visits each year include wound care, emergency care prov... more As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence-based approach and consider each wound individually in order to create the optimal conditions for wound healing. A comprehensive evidence-based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls. A systematic review of the literature for acute wound management was performed. A structured MEDLINE search was performed regarding acute wound management including es...
All chronic wounds are colonized by micro-organisms. Although the presence of bacteria is not nec... more All chronic wounds are colonized by micro-organisms. Although the presence of bacteria is not necessarily harmful, and may be beneficial in some instances, accurate evaluation of wound-related bacterial damage and infection is crucial. A cross-sectional validation study involving 112 patients was conducted to estimate the specificity and sensitivity of clinical assessment variables individually and in combination to determine the presence and quantity of bacteria in the wound. The average age of study participants was 66 years (range 33 to 95 years) and most had leg (44) and foot (68) ulcers of approximately 6 months' duration. Wounds were evaluated using a mnemonic developed to evaluate the presence or absence of clinical signs of critical colonization (NERDS) or infection (STONEES) and results compared to semi-quantitative swab cultures. Wounds with debris, increased exudate, and friable tissue were found to be five times more likely to have scant or light bacterial growth; wh...
Although complete healing may appear to be the logical goal for most patients and clinicians, som... more Although complete healing may appear to be the logical goal for most patients and clinicians, some wounds do not have the potential to heal due to a number of factors such as inadequate vasculature, coexisting medical conditions and medications that prohibit the healing process. Local management of wounds that are considered to have poor potential for healing remains elusive. The purpose of this article is to review the evidence that supports the use of topical antiseptic agents in non-healable wounds. Retrospective chart audit was conducted to evaluate the use of povidone iodine in the management of wounds that were deemed to have poor healing potential.
This supplement was subject to Ostomy Wound Management peer-review process. It was not subject to... more This supplement was subject to Ostomy Wound Management peer-review process. It was not subject to the WOUNDS peer-review process and is provided as a courtesy to WOUNDS subscribers.
The optimal treatment for hypertensive patients with atherosclerotic renal artery stenosis is con... more The optimal treatment for hypertensive patients with atherosclerotic renal artery stenosis is controversial. We performed a meta-analysis comparing the effects of balloon angioplasty and medical therapy in these patients. We searched MEDLINE, EMBASE, the Science Citation Index, the Cochrane Controlled Trials Registry, and reference lists. Authors of published trials were contacted. We identified three trials involving a total of 210 patients with moderate-to-severe (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 50%) unilateral or bilateral atherosclerotic renal artery stenosis and poorly controlled hypertension who were followed for at least 3 months after intervention. Balloon angioplasty was significantly more effective in reducing blood pressure than was medical therapy; the weighted mean difference between the two treatments was -7 mm Hg (95% confidence interval [CI]: -12 to -1 mm Hg) for systolic blood pressure and -3 mm Hg (95% CI: -6 to -1 mm Hg) for diastolic blood pressure. There was no consistent difference in changes in renal function. Patients treated with balloon angioplasty were more likely to have patent renal arteries after 12 months (52% vs. 19%; odds ratio [OR] = 4.2; 95% CI: 1.8 to 9.8), used fewer antihypertensive medications, and appeared to have fewer major cardiovascular and renovascular complications (OR = 0.27; 95% CI: 0.06 to 1.23; P = 0.09). Balloon angioplasty has a modest but significant effect on blood pressure and should be considered for patients with atherosclerotic renal artery stenosis and poorly controlled hypertension. There is no evidence supporting its use in improving or preserving renal function, although none of the trials were designed to address this issue.
OBJECTIVE: A randomized controlled trial to evaluate the effectiveness of a polyhexamethylene big... more OBJECTIVE: A randomized controlled trial to evaluate the effectiveness of a polyhexamethylene biguanide (PHMB) foam dressing compared with a similar non-antimicrobial foam for the treatment of superficial bacterial burden, wound-associated pain, and reduction in wound size. SETTING AND PARTICIPANTS: This study was conducted in 2 wound healing clinics-a university hospital-based clinic and a community-based clinic. Forty-five chronic wound subjects, stratified to either foot or leg ulcers, were followed for 5 weeks. METHODS: A multicenter, prospective, double-blind, pilot, randomized controlled clinical trial with 3 study visits (Weeks 0, 2, 4) documented pain and local wound characteristics using NERDS and STONEES clinical criteria to determine superficial bacterial damage or deep/surrounding infection. RESULTS: The use of PHMB foam dressing was a significant predictor of reduced wound superficial bacterial burden (P = .016) at week 4 as compared with the foam alone. Pain reduction was also statistically significant at week 2 (P = .0006) and at week 4 (P = .02) in favor of the PHMB foam dressings. Polymicrobial organisms were recovered at week 4 in 5.3% in the PHMB foam dressing group versus 33% in the control group (P = .04). Subjects randomized to the PHMB foam dressing had a 35% median reduction in wound size by week 4, compared with 28% in the control group. CONCLUSIONS: PHMB foam dressing successfully reduced chronic wound pain and bacterial burden. KEYWORDS: polyhexamethylene biguanide foam dressing, antimicrobial foam dressing, reduction of bacterial burden and pain in chronic wounds
has disclosed that she has no significant relationships with or financial interest regarding this... more has disclosed that she has no significant relationships with or financial interest regarding this educational activity. Ms Garde has disclosed that she has no significant relationships with or financial interest regarding this educational activity. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute has identified and resolved all faculty and staff conflicts of interest regarding this educational activity. This continuing education activity will expire for physicians on November 30, 2010.
Aim: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES)... more Aim: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). Design: Prospective psychometric instrument validation study. Method: OASES was developed based on a literature review and expert input (n=19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. Results: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI=0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01 and 0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p<0.001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI=0.78-0.86) for the full instrument, and varied between 0.72 (95% CI=0.64-0.79) and 0.85 (95% CI=0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. Conclusion: OASES is supported by acceptable psychometric properties and can be applied in nursing education, research and practice to assess knowledge of healthcare professionals about skin tears. Impact: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice and research needs and priorities related to skin tears in clinical practice.
Research is limited on how nurses in community settings manage ethical conflicts. To address this... more Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty (“Should I be addressing what I think is a moral problem?”). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.
66 l Nursing2019 l Volume 49, Number 4 www.Nursing2019.com S KIN TEARS have historically been unr... more 66 l Nursing2019 l Volume 49, Number 4 www.Nursing2019.com S KIN TEARS have historically been unrecognized by patients and caregivers in most circumstances, but they can become chronic and difficult to manage when left untreated.1,2 As the skin becomes drier, less elastic, and more vulnerable as one ages, skin tears become more common, particularly in older adults.1,2 This article reviews the prevalence, prevention, assessment, and management of skin tears with the goal of reducing misdiagnosis and promoting evidence-based management.
Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chron... more Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chronic health condition often associated with a prolonged healing trajectory and frequent recurrence. It is estimated that approximately 1.5 to 3.0 per 1,000 adults have active leg ulcers, and the prevalence continues to increase due to an aging population. Management of chronic edema using compression is crucial to promote healing of venous leg ulcers. The principle of compression therapy is simple, involving the use of external pressure in the forms of bandages or wraps to move the fluid from the interstitial space back into the intravascular compartment and prevent reflux. This article synthesizes and appraises the evidence for various types of compression therapies. It also addresses best practice recommendations for the management of leg ulcers when arterial circulation is considered suboptimal.
To provide the practitioner with current information on the most common nail disorders. This cont... more To provide the practitioner with current information on the most common nail disorders. This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders. After reading this article and taking this test, the reader should be able to: 1. Describe the structures that compose the nail apparatus. 2. Identify the most common nail disorders, including etiology and treatment.
Background The older adult population in Canada is increasing, and many will require care within ... more Background The older adult population in Canada is increasing, and many will require care within an acute geriatric unit (AGU) or long-term care facility (LTCF). However, the nursing workforce is not growing at the same pace as the population is aging. New graduate nurses may be able to fill this gap; therefore, it is important to understand their intentions of working in gerontological care settings (i.e., AGU or LTCF). Aim To examine if nursing education and personal attitudes toward older adults influence newly registered nurses’(RNs) intentions to work in a gerontological care setting. Method Nurses (n= 1,103) who registered with the College of Nurses of Ontario for the first time in 2018 were invited to complete a questionnaire. Results The majority of participants (n = 181) reported a positive attitude toward older adults. However, only 14% reported an intention to work in a gerontological care setting. Participants who completed multiple geriatric focused clinical placements ...
Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture... more Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from ...
The aim of this study was to summarise the clinical evidence supporting almost 40 years of topica... more The aim of this study was to summarise the clinical evidence supporting almost 40 years of topical cadexomer iodine (CIOD) use in wound bed preparation by removing barriers to healing such as exudate, slough, bioburden, and infection and allowing chronic wound progression. A systematic review was conducted (Embase/PubMed, November 2020) to identify relevant compara-K E Y W O R D S cadexomer iodine, desloughing, exudate, infection, wound healing Kevin Woo and Caroline Dowsett are co-first authors.
Background: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private fo... more Background: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods: A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results: The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate use of PU prevention materials, the empowering of staff to improve the quality of PU care, and improved home management. Conclusion: Through the action research approach, the care staff were empowered and their PU prevention care practices had improved, which contributed to the decreased incidence of pressure ulcers. A PU prevention protocol that was accepted by the staff was finally developed as the standard of care for such homes.
International journal of emergency medicine, Jan 27, 2010
As millions of emergency department (ED) visits each year include wound care, emergency care prov... more As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence-based approach and consider each wound individually in order to create the optimal conditions for wound healing. A comprehensive evidence-based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls. A systematic review of the literature for acute wound management was performed. A structured MEDLINE search was performed regarding acute wound management including es...
All chronic wounds are colonized by micro-organisms. Although the presence of bacteria is not nec... more All chronic wounds are colonized by micro-organisms. Although the presence of bacteria is not necessarily harmful, and may be beneficial in some instances, accurate evaluation of wound-related bacterial damage and infection is crucial. A cross-sectional validation study involving 112 patients was conducted to estimate the specificity and sensitivity of clinical assessment variables individually and in combination to determine the presence and quantity of bacteria in the wound. The average age of study participants was 66 years (range 33 to 95 years) and most had leg (44) and foot (68) ulcers of approximately 6 months' duration. Wounds were evaluated using a mnemonic developed to evaluate the presence or absence of clinical signs of critical colonization (NERDS) or infection (STONEES) and results compared to semi-quantitative swab cultures. Wounds with debris, increased exudate, and friable tissue were found to be five times more likely to have scant or light bacterial growth; wh...
Although complete healing may appear to be the logical goal for most patients and clinicians, som... more Although complete healing may appear to be the logical goal for most patients and clinicians, some wounds do not have the potential to heal due to a number of factors such as inadequate vasculature, coexisting medical conditions and medications that prohibit the healing process. Local management of wounds that are considered to have poor potential for healing remains elusive. The purpose of this article is to review the evidence that supports the use of topical antiseptic agents in non-healable wounds. Retrospective chart audit was conducted to evaluate the use of povidone iodine in the management of wounds that were deemed to have poor healing potential.
This supplement was subject to Ostomy Wound Management peer-review process. It was not subject to... more This supplement was subject to Ostomy Wound Management peer-review process. It was not subject to the WOUNDS peer-review process and is provided as a courtesy to WOUNDS subscribers.
The optimal treatment for hypertensive patients with atherosclerotic renal artery stenosis is con... more The optimal treatment for hypertensive patients with atherosclerotic renal artery stenosis is controversial. We performed a meta-analysis comparing the effects of balloon angioplasty and medical therapy in these patients. We searched MEDLINE, EMBASE, the Science Citation Index, the Cochrane Controlled Trials Registry, and reference lists. Authors of published trials were contacted. We identified three trials involving a total of 210 patients with moderate-to-severe (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 50%) unilateral or bilateral atherosclerotic renal artery stenosis and poorly controlled hypertension who were followed for at least 3 months after intervention. Balloon angioplasty was significantly more effective in reducing blood pressure than was medical therapy; the weighted mean difference between the two treatments was -7 mm Hg (95% confidence interval [CI]: -12 to -1 mm Hg) for systolic blood pressure and -3 mm Hg (95% CI: -6 to -1 mm Hg) for diastolic blood pressure. There was no consistent difference in changes in renal function. Patients treated with balloon angioplasty were more likely to have patent renal arteries after 12 months (52% vs. 19%; odds ratio [OR] = 4.2; 95% CI: 1.8 to 9.8), used fewer antihypertensive medications, and appeared to have fewer major cardiovascular and renovascular complications (OR = 0.27; 95% CI: 0.06 to 1.23; P = 0.09). Balloon angioplasty has a modest but significant effect on blood pressure and should be considered for patients with atherosclerotic renal artery stenosis and poorly controlled hypertension. There is no evidence supporting its use in improving or preserving renal function, although none of the trials were designed to address this issue.
OBJECTIVE: A randomized controlled trial to evaluate the effectiveness of a polyhexamethylene big... more OBJECTIVE: A randomized controlled trial to evaluate the effectiveness of a polyhexamethylene biguanide (PHMB) foam dressing compared with a similar non-antimicrobial foam for the treatment of superficial bacterial burden, wound-associated pain, and reduction in wound size. SETTING AND PARTICIPANTS: This study was conducted in 2 wound healing clinics-a university hospital-based clinic and a community-based clinic. Forty-five chronic wound subjects, stratified to either foot or leg ulcers, were followed for 5 weeks. METHODS: A multicenter, prospective, double-blind, pilot, randomized controlled clinical trial with 3 study visits (Weeks 0, 2, 4) documented pain and local wound characteristics using NERDS and STONEES clinical criteria to determine superficial bacterial damage or deep/surrounding infection. RESULTS: The use of PHMB foam dressing was a significant predictor of reduced wound superficial bacterial burden (P = .016) at week 4 as compared with the foam alone. Pain reduction was also statistically significant at week 2 (P = .0006) and at week 4 (P = .02) in favor of the PHMB foam dressings. Polymicrobial organisms were recovered at week 4 in 5.3% in the PHMB foam dressing group versus 33% in the control group (P = .04). Subjects randomized to the PHMB foam dressing had a 35% median reduction in wound size by week 4, compared with 28% in the control group. CONCLUSIONS: PHMB foam dressing successfully reduced chronic wound pain and bacterial burden. KEYWORDS: polyhexamethylene biguanide foam dressing, antimicrobial foam dressing, reduction of bacterial burden and pain in chronic wounds
has disclosed that she has no significant relationships with or financial interest regarding this... more has disclosed that she has no significant relationships with or financial interest regarding this educational activity. Ms Garde has disclosed that she has no significant relationships with or financial interest regarding this educational activity. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute has identified and resolved all faculty and staff conflicts of interest regarding this educational activity. This continuing education activity will expire for physicians on November 30, 2010.
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