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August is upon us which means September isn't far away and that means time for the Scottish Conference, now in its 8th successful year, to be held in the Glasgow Thistle Hotel. To be held on 6th September sessions include pressure ulcers, surgical and trauma wounds and wound debridement. For more information and to book a place visit www.wounds-uk.com
Wounds UK and Biofisica are staging a series of one-day workshops around England during September entitled Current Affairs in Wound Care. The itinerary is Bristol on 10th, Cobham (London) 11th, Aston Villa (Birmingham) 13th and Manchester City Stadium on 14th. Book your place and one for any manager involved in the commissioning or procurement of wound care products and services by visiting www.wounds-uk.com or by contacting the conference coordinator at the Biofisica office on 01256 704555.
Venous Thrombo-embolism - The CNO Bulletin (England) June 2007 http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/Chiefnursingofficerbulletin/DH_075453 carries the article 'VTE risk assessments for all hospital patients'. This is the aim of an expert group who are developing a national risk assessment tool and guidance to put this into practice, which has got to be good news for any TVN who has ever tried to get a policy together on this topic.
There were 44451 admissions in England in 2005-06 for 'cellulitis of other part of the limb' the most likely category for lower leg cellulitis. These admissions amounted to 372,912 bed days, and using the £250 per bed day figure, a whopping £93,228,000 estimated cost. So early recognition and treatment in the community could impact on this total, and a part of this responsibility lies with professionals engaged in wound care. Remember to get it early, wound infection is a clinical diagnosis, so don't wait for the return of the wound swab to treat it, and use antiseptic dressings for wounds with critical colonisation which could prevent onward transmission to infection. Find out your own statistics on:- http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=537 Community Health Profiles for England - Writing an article or assignment and need the background on the health of your local population? Then go to http://www.communityhealthprofiles.info .The profiles produced by the Association of Public Health Observatories are designed to help local government and PCTs tackle health inequalities (but are also useful to find out where the posh people live!).
This month the Mann Whitney U Test was in a table in a piece by Henderson (2007) (see reference list). The table was taken directly from a referenced article so without looking up the original work there was no further data to go on. The original work used the test to determine if the difference in healing times of pretibial lacerations either adhesive taped or sutured was significant. The Mann Whitney is used to compare two small groups and assumes the spread of the data in each group is similar, though it does not necessarily have to form a normal distribution which plotted on a graph would look bell-shaped. It, however, does require the sampling to be properly random (and not a convenience sample) and that the people in the two groups are different. Flap laceration in the group closed by adhesive tape healed statistically significantly faster than the sutured flap group. However, given that the table presented gives no confidence intervals for the mean number of days to healing we have no idea about the spread of the scores in each group. Therefore we can not really be sure how much we can rely on the means, in this case 39 days in the taped group and 53 days for the sutured, to represent closely the closure times for the majority of wounds that underwent the procedures. Wide intervals give little and narrow ones give us more confidence that the mean is really representative of the data. Statistical significance is all well and good but if the distribution of the data on which the sums are done is widely spread we have to question the value of the result. Significance is shown by 'p value' which stands for the probability that the result happened by chance was 1 in however many. The p=0.05 value, the cut off point for statistical significance, means there was a 1 in 20 probability that the result happened by random chance rather than it being a 'true' difference produced by the treatment. The lower the p value the better, for example 0.01 means a 1 in 100 probability of the result happening by pure chance. The test in the paper examined the difference between the mean averages of days to healing in the two groups. Given the minimal information provided in the paper (which was no fault of the author as there was minimal material in the original publication), and being the generous souls that we are, we can only presume that the data was sufficient and sound enough to undergo the statistical testing. Then with this presumption in place, and it is a big one, the result gives a clinically significant result.
Sources:http://www.statisticssolutions.com/mann.htm
Taubert, D., Roesen, R., Lehmann C. et al (2007) Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide: A Randomized Controlled Trial. JAMA. 298: 49 - 60.
Bawden R, Lindsay E (2007) Patient empowerment: a general practice perspective. Wound Care. June: (suppl. to Brit J Nurs.); S28 - S30 Jankunas, V., Bagdonas,R., Samsanavicius, D., Rimdeika R. (2007) An analysis of the effectiveness of skin grafting to treat chronic venous leg ulcers. Wounds. 19: 5; 128 - 137 Jones JE, Nelson EA. Skin grafting for venous leg ulcers. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001737. Review. Burch J, Jones M. Pyoderma gangrenosum and leg ulcers associated with vasculitis: importance of addressing the underlying disease process when treating inflammatory wounds. J Wound Ostomy Continence Nurs. 2006 Jan-Feb;33(1):77-81; discussion 81-2. Review. No abstract available. Foot Ulcers Kravitz SR, McGuire JB, Sharma S. The treatment of diabetic foot ulcers: reviewing the literature and a surgical algorithm. Adv Skin Wound Care. 2007 Apr;20(4):227-37; quiz 237-9. Review. Pressure Ulcers Rieger U, Scheufler O, Schmid D, Zweifel-Schlatter M, Kalbermatten D, Pierer G. Six treatment principles of the basle pressure sore concept.] Handchir Mikrochir Plast Chir. 2007 Jun;39(3):206-14. German. Abstract english Jones KR, Fennie K. Factors influencing pressure ulcer healing in adults over 50: an exploratory study. J Am Med Dir Assoc. 2007 Jul;8(6):378-87. Epub 2007 Jun 14. Burns Singer AJ, Brebbia J, Soroff HH. Management of local burn wounds in the ED. Am J Emerg Med. 2007 Jul;25(6):666-71. Review. Gómez R, Cancio LC Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007 Feb;25(1):135-46 Gravante G, Esposito G, di Fede MC, Delogu D, Montone A. Versajet hydrosurgery in burn wound debridement: a preliminary experience. Burns. 2007 May;33(3):401-2. No abstract available. Feng Y, Huo R, Fu H, Li Q, Lv R, Wang Y, Wang D. Dermabrasion with steel wool in the extensive partial burns during shock stage: a case report and review. Burns. 2007 Jun;33(4):526-9. Epub 2007 Jan 22. No abstract available. Baldursdottir ME, Kristjansdottir G. A clinical case study of a participation intervention method for burn dressing change in two children. Burns. 2007 Jun;33(4):518-21. Epub 2006 Nov 22. No abstract available. Minor Trauma Henderson, V. (2007) Treatment options for pretibial lacerations. Wound Care. June: (suppl. to Brit J Nurs.); S22 - S30 Reynolds T, Cole E. Techniques for acute wound closure. Nurs Stand. 2006 Feb 1-7;20(21):55-64 quiz 66, 68 Vascular Klonaris C, Georgopoulos S, Katsargyris A, Tsekouras N, Bakoyiannis C, Giannopoulos A, Bastounis E. Changing patterns in the etiology of acute lower limb ischemia. Int Angiol. 2007 Mar;26(1):49-52. Surgical Parker M, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001825. Gurusamy KS, Samraj K. Wound drains after incisional hernia repair. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD005570 Marco F, Vallez R, Gonzalez P, Ortega L, de la Lama J, Lopez-Duran L. Study of the efficacy of coated vicryl plus((r)) antibacterial suture in an animal model of orthopedic surgery. Surg Infect (Larchmt). 2007 Jun;8(3):359-66. Bellows CF, Albo D, Berger DH, Awad SS. Abdominal wall repair using human acellular dermis. Am J Surg. 2007 Aug;194(2):192-8. Whitby M, McLaws ML, Doidge S, Collopy B. Post-discharge surgical site surveillance: does patient education improve reliability of diagnosis? J Hosp Infect. 2007 Jul;66(3):237-42. Epub 2007 Jun 19. Koval KJ, Egol KA, Hiebert R, Spratt KF. Tape blisters after hip surgery: can they be eliminated completely? Am J Orthop. 2007 May;36(5):261-5. Battle J, Carmichael KD. Incidence of pin track infections in children's fractures treated with Kirschner wire fixation. J Pediatr Orthop. 2007 Mar;27(2):154-7. Dermatology Baharestani MM. An overview of neonatal and pediatric wound care knowledge and considerations. Ostomy Wound Manage. 2007 Jun;53(6):34-55. Mozaffari H, Pourpak Z, Pourseyed S, Farhoodi A, Aghamohammadi A, Movahadi M, Gharaghozloo M, Moin M. Quality of life in atopic dermatitis patients. J Microbiol Immunol Infect. 2007 Jun;40(3):260-4. PMID: 17639168 [PubMed - in process] Ali SM, Brodell RT, Balkrishnan R, Feldman SR. Poor adherence to treatments: a fundamental principle of dermatology. Arch Dermatol. 2007 Jul;143(7):912-5. No abstract available. DinulosJG. Pediatric dermatology: past, present and future. Curr Opin Pediatr. 2007 Aug;19(4):417-9. No abstract available. Grillo M, Long R, Long D. Habit reversal training for the itch-scratch cycle associated with pruritic skin conditions. Dermatol Nurs. 2007 Jun;19(3):243-8. PMID: 17626502 [PubMed - in process] Courtenay M, Carey N, Burke J. Independent extended nurse prescribing for patients with skin conditions: a national questionnaire survey. J Clin Nurs. 2007 Jul;16(7):1247-55. Foti C, Bonamonte D, Conserva A, Angelini G. Allergic contact dermatitis to regenerated oxidized cellulose contained in a matrix employed for wound therapy. Contact Dermatitis. 2007 Jul;57(1):47-8. Eminovic N, de Keizer NF, Bindels PJ, Hasman A. Maturity of teledermatology evaluation research: a systematic literature review. Br J Dermatol. 2007 Mar;156(3):412-9. Review. English JS, Eedy DJ. Has teledermatology in the U.K. finally failed? Br J Dermatol. 2007 Mar;156(3):411. No abstract available. Debridement Stephen-Haynes, J., Thompson, G. (2007) The different methods of wound debridement. Wound Care. June: (suppl. to Brit J Nurs.); S6 - S16 Exudate Brett DW. A review of moisture-control dressings in wound care. J Wound Ostomy Continence Nurs. 2006 Nov-Dec;33(6 Suppl):S3-8. Infection Ghiselli R, Cirioni O, Giacometti A, Scalise A, Simonetti O, Mocchegiani F, Orlando F, Goteri G, Della Vittoria A, Filosa A, Silvestri C, Offidani A, Bertani A, Scalise G, Saba V. Comparative Efficacy of Topical Versus Systemic Teicoplanin in Experimental Model of Wound Infections. J Surg Res. 2007 Jun 13; [Epub ahead of print] Yarboro SR, Baum EJ, Dahners LE. Locally administered antibiotics for prophylaxis against surgical wound infection. An in vivo study. J Bone Joint Surg Am. 2007 May;89(5):929-33. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004985. Review. Tschachler E, Brockmeyer N, Effendy I, Geiss HK, Harder S, Hartmann M, Jappe U, Plettenberg A, Rasokat H, Reimann H, Shah P, Stucker M, Wichelhaus TA, Schofer H; German Society of Dermatology. Streptococcal infections of the skin and mucous membranes. J Dtsch Dermatol Ges. 2007 Jun;5(6):527-32. English, German. No abstract available. Pain Barrett, S. (2007) 'Heal not hurt': piloting an initiative n wound pain assessment. Wound Care. June: (suppl. to Brit J Nurs.); S18 - S21 Evans E, Gray M. Do topical analgesics reduce pain associated with wound dressing changes or debridement of chronic wounds? J Wound Ostomy Continence Nurs. 2005 Sep-Oct;32(5):287-90. Review. No abstract available. Fungating wounds Adderley U, Smith R. Topical agents and dressings for fungating wounds. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003948. Review. Scars Iannello S, Milazzo P, Bordonaro F, Belfiore F. Low-dose enalapril in the treatment of surgical cutaneous hypertrophic scar and keloid--two case reports and literature review. MedGenMed. 2006 Dec 20;8(4):60. Review. Topical Negative Pressure Baharestani MM. Use of negative pressure wound therapy in the treatment of neonatal and pediatric wounds: a retrospective examination of clinical outcomes. Ostomy Wound Manage. 2007 Jun;53(6):75-85. Wada A, Ferreira MC, Tuma Junior P, Arrunategui G. Experience with local negative pressure (vacuum method) in the treatment of complex wounds. Sao Paulo Med J. 2006 May 4;124(3):150-3. Hyperbaric oxygen Gray M, Ratliff CR. Is hyperbaric oxygen therapy effective for the management of chronic wounds? J Wound Ostomy Continence Nurs. 2006 Jan-Feb;33(1):21-5. Review. No abstract available. Various Wong, T., McGrath, J., Navsaria, H. (2007) The role of fibroblasts in tissue engineering and regeneration. The British Journal of Dermatology. 156: 6; 1149 - 1155 Boyd M, Flasza M, Johnson PA, Roberts JS, Kemp P. Integration and persistence of an investigational human living skin equivalent (ICX-SKN) in human surgical wounds. Regen Med. 2007 Jul;2(4):363-70. Metcalfe AD, Ferguson MW. Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface. 2007 Jun 22;4(14):413-37. Review. Hodde J. Extracellular matrix as a bioactive material for soft tissue reconstruction. ANZ J Surg. 2006 Dec;76(12):1096-100. Review. Carlisle D. Payment by results. How crude tariffs are getting under the skin of specialists. Health Serv J. 2007 Apr 19;117(6052):14-5. No abstract available.
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Download this newsletter in PDF formatAugust 2007 |
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