New and Updated Cochrane Systematic Reviews

Here, Biglari et al determine the effectiveness of platelet-rich plasma (PRP) in the treatment of nonhealing fistula in spinal cord-injured patients. After 1 week of treatment with PRP, the authors observed low levels of secretion from the fistulas. After 2 weeks, they noted no further secretion from the fistulas. A magnetic resonance imaging control investigation after 3 weeks showed the complete disappearance of the fistulas. No negative effects and no allergic reactions were noted in the use of PRP. The results suggest that the application of PRP in combination with debridement is an effective therapy option and good alternative to recurrent surgical interventions for treating nonhealing fistulas resulting from the surgical closure of PrUs. [PUBLICATION] 29 references Source: BNI 2.Title: A new quality of life consultation template for patients with venous leg ulceration Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 140-148, 0969-0700 (March 2015) Author(s): Green, J., Jester, R., McKinley, R., Pooler, A., Mason, S., Redsell, S. Abstract: Objective: Chronic venous leg ulcers (CVLUs) are common and recurrent, however, care for patients predominantly has a focus which overlooks the impact of the condition on quality of life. The aim of this study was to develop a simple, evidence-based consultation template, with patients and practitioners, which focuses consultations on quality of life themes. Method: A nominal group was undertaken to develop a new consultation template for patients with CVLUs based on the findings of earlier qualitative study phases. Results: A user-friendly two-sided A4 template was designed to focus nurse-patient consultations on the quality of life challenges posed by CVLUs. Conclusion: CVLUs impact negatively on the quality of life of the patient but this receives inadequate attention during current consultations. This new template will help to ensure that key concerns are effectively raised, explored and addressed during each consultation. [PUBLICATION] 42 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 3.Title: A novel in vitro wound biofilm model used to evaluate low-frequency ultrasonic-assisted wound debridement Citation: Journal of Wound Care, Feb 2015, vol. 24, no. 2, p. 64-72, 0969-0700 (February 2015) Author(s): Crone, S., Garde, C., Bjarnsholt, T., Alhede, M. Abstract: Objective: Bacterial biofilms remain difficult to treat. The biofilm mode of growth enables bacteria to survive antibiotic treatment and the inflammatory reaction. Low-frequency ultrasound has recently been shown to improve healing in a variety of settings. It is hypothesised that ultrasound disrupts the biofilm leaving bacteria more vulnerable to antiseptic or antibiotic treatment. The objective of this study is to develop a realistic model to elucidate the effect of ultrasound on biofilms. Method: A novel in vitro wound biofilm model was developed. Biofilms of Staphylococcus aureus were casted in a semi-solid agar gel composed of either tryptic soy broth (TSB) or a wound simulating media (WSM; composed of Bolton broth with blood and plasma), to resemble the non-surface attached aggregates. The model was used to evaluate the antibiofilm effect of an ultrasonic-assisted wound debridement device (UAW) in the presence of saline irrigation and treatment with a polyhexamethylene biguanide (PHMB)-containing antiseptic. Confocal microscopy was used to evaluate the effect of treatments on biofilm disruption and cell viability counting measured the antibacterial effects. Results: Confocal microscopy showed that application of 10 seconds of moderate-intensity UAW could effectively disrupt semi-solid biofilms grown on both media settings. This treatment only had a small effect on the cell viability. A 24hour treatment with PHMB was able to reduce the number of bacteria but not eradicate the biofilm in both media settings. Interestingly, the efficacy of the PHMB antiseptic was significantly higher when applied on biofilms grown in the more complex WSM media. However, we found a significant improvement in reducing the number of viable bacteria grown on both media when applying UAW before administration of the PHMB solution. Applying UAW in the presence of PHMB further improved the efficacy. Conclusion: Using a realistic in vitro biofilm wound model, we show combining UAW with a PHMB-containing antiseptic has potential as an antibiofilm strategy in wound care. [PUBLICATION] 45 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 4.Title: A portable, disposable system for negative-pressure wound therapy Citation: British Journal of Nursing, Jan 2015, vol. 24, no. 2, p. 98-106, 0966-0461 (January 22, 2015) Author(s): Brandon, Tanya Abstract: Negative-pressure wound therapy (NPWT) imparts a number of clinical effects that promote a healing response and, as such, is a well-established means of treating a variety of wound types. Historically, the technique has been primarily used in the hospital setting; however, the introduction of more portable devices has led to an increase in the use of NPWT in the home care setting, thereby facilitating early discharge of patients from hospital and continuity of care in the community. Portable NPWT devices also have the potential to impact positively on patients' quality of life, allowing increased mobility and freedom to undertake normal activities of daily living. Following the development of its standard Avarice® NPWT system and associated dressing kits, Molnlycke Health Care (Gothenburg, Sweden) has introduced a singlepatient-use, disposable NPWT system; Avance Solo. This has been developed with a view to maximising patient freedom and mobility, providing a single-patient-use NPWT solution for multi-week treatment to allow quick and easy discharge of patients from hospital to home, and reducing some of the challenges of logistics and administration associated with the provision of NPWT for the caregiver. As with the standard NPWT system, the single-patient use system is supplied with a number of products incorporating Safetac® adhesive technology to minimise the risk of patients suffering unnecessary pain and trauma associated with dressing changes. This article presents a series of case studies describing procedures and outcomes following the application of the Avance Solo single-patient-use system. [PUBLICATION] 56 references Source: BNI Full text: Available British journal of nursing (Mark Allen Publishing) at British Journal of Nursing 5.Title: A prospective, longitudinal, descriptive study of the effect of a customized wheelchair cushion on clinical variables, satisfaction, and functionality among patients with spinal cord injury Citation: Ostomy Wound Management, Feb 2015, vol. 61, no. 2, p. 26-36, 0889-5899 (February 2015) Author(s): Vilchis-Aranguren, Rodrigo, Gayol-Mérida, Diana, Quinzaños-Fresnedo, Jimena, Pérez-Zavala, Ramiro, GalíndezNovoa, Carmen Abstract: The Instituto Nacional de Rehabilitacion (Rehabilitation National Institute) (INR) developed a prototype wheelchair cushion (INR cushion) designed to adjust to the anthropometry of the user's ischiogluteal area and prevent pressure ulcer formation while maintaining or promoting functionality. A prospective, longitudinal, descriptive study was conducted from February 2010 to February 2011 to evaluate the effect of using the INR cushion on clinical variables, functionality, and user satisfaction. Sixteen patients were recruited (9 male, 7 female, average age 31.8 [range 22-47] years, average body mass index 25 [range 22-34], average time in a wheelchair 10.1 [range 3-26] years) who met the study protocol inclusion criteria of being pressure ulcer-free for at least 6 months and capable of propulsion and transfer without assistance, chronic spinal cord injury (2 years), and without chronic-degenerative diseases or cognitive problems. Each participant received the cushion for a 2-month evaluation. Eight clinical variables were assessed: trunk control, posture, spasticity, transfer capacity, comfort, skin reaction, propulsion capacity, and pressure release capacity. The clinical assessment was performed using validated scales and instruments: Modified Ashworth Scale (MAS), Functional Independence Measure(TM) (FIM), Norton Scale, and assessment of skin reaction. Interface pressures were measured using force sensing array, and participants completed a structured interview to assess user expectation, perceived functionality, perceived quality, and likelihood of recommending the device. Two patients withdrew due to appointment conflicts; of the remaining 14, significant differences between the user's experience with other products and the INR were found with regard to pressure redistribution (P = 0.012); all participants but 1 graded the INR as good in all interview categories. No participants developed a pressure ulcer during the study. The customized cushion was especially functional among patients with incomplete thoracic and cervical injuries, high FIM scores, and moderate levels of activities of daily living. Taller patients (P = 0.01) and patients with higher degrees of spasticity (P = 0.007) were less satisfied with functionality. The results of this study contributed to the redesign process of the cushion. These findings may be useful to establish predictors, both subjective and clinical, for patient utilization of wheelchair cushion use. [Publication] 30 references Source: BNI 6.Title: A prospective, randomized, controlled trial comparing the effects of noncontact, low-frequency ultrasound to standard care in healing venous leg ulcers Citation: Ostomy Wound Management, Jan 2015, vol. 61, no. 1, p. 16-29, 0889-5899 (January 2015) Author(s): Gibbons, Gary W, Orgill, Dennis P, Serena, Thomas E, Novoung, Aksone, O'Connell, Jessica B, Li, William W, Driver, Vickie R Abstract: Current scientific evidence suggests venous leg ulcers (VLUs) that do not respond to guideline-defined care may have a wound microenvironment that is out of physiological balance. A prospective, randomized, controlled, multicenter trial was conducted to compare percent wound size reduction, proportions healed, pain, and quality-of-life (QOL) outcomes in patients randomized to standard care (SC) alone or SC and 40 kHz noncontact, low-frequency ultrasound (NLFU) treatments 3 times per week for 4 weeks. One hundred, twelve (112) eligible participants with documented venous stasis, a VLU 30 days' duration, measuring 4 cm... to 50 cm..., and demonstrated arterial flow were enrolled. Of these, 81 reduced 30% in size during the 2-week run-in study phase and were randomized (SC, n = 40; NLFU+SC, n = 41). Median age of participants was 59 years; 83% had multiple complex comorbidities. Index ulcers were 56% recurrent, with a median duration of 10.3 months (range 1 month to 204.5 months) and median ulcer area of 11.0 cm... (range 3.7 cm2-41.3 cm...). All participants received protocol-defined SC compression (30-40 mm Hg), dressings to promote a moist wound environment, and sharp debridement at the bedside for a minimum of 1 time per week. Ulcer measurements were obtained weekly using digital planimetry. Pain and QOL scores were assessed at baseline and after 4 weeks of treatment using the Visual Analog Scale and the Short Form-36 Health Survey. After 4 weeks of treatment, average wound size reduction was 61.6% ± 28.9 in the NLFU+SC compared to 45% ± 32.5 in the SC group (P = 0.02). Reductions in median (65.7% versus 44.4%, P = 0.02) and absolute wound area (9.0 cm... versus 4.1 cm..., P = 0.003) as well as pain scores (from 3.0 to 0.6 versus 3.0 to 2.4, P = 0.01) were also significant. NLFU therapy with guideline-defined standard VLU care should be considered for healing VLUs not responding to SC alone. The results of this study warrant further research on barriers to healing and the changes occurring in the tissue of the wound to explore theories that the microenvironment impacts wounds that do not heal despite provision of guideline-defined care. (ProQuest: ... denotes formulae/symbols omitted.) [Publication] 46 references Source: BNI 7.Title: A real-life clinical evaluation of a next-generation antimicrobial dressing on acute and chronic wounds Citation: Journal of Wound Care, Jan 2015, vol. 24, no. 1, p. 11-22, 0969-0700 (January 2015) Author(s): Walker, M., Metcalf, D., Parsons, D., Bowler, P. Abstract: Objective: To assess the effectiveness of a new, next-generation antimicrobial dressing (AQUACEL Ag+ dressing) in facilitating healing in a variety of hard-to-heal wounds that may have been compromised by infection and/or biofilm. Method: This was an international, multi-centred, real-life, non-randomised evaluation involving patients with a wide variety of slow-, non-healing or deteriorating chronic and acute wounds. There were no strict inclusion or exclusion criteria and the clinicians were asked to use their discretion in the selection of patients. The clinicians continued to use their standard protocol of care but replaced their existing primary wound-contact dressing with the next-generation antimicrobial dressing (NGAD) for up to 4 weeks. Clinicians could extend the treatment period if this was deemed clinically appropriate. Baseline assessments included wound bed characteristics, exudate level, indicators of wound biofilm, and signs and symptoms of infection. At the final assessment, the investigators reported the wound size, wound bed characteristics, and exudate level. Results: A total of 121 patients were recruited into the original evaluation, of which eight were excluded for incomplete data sets. Most wounds (73; 64%) were either venous leg ulcers (59; 52%) or diabetic foot ulcers (14; 12%). At baseline, the wounds of (26; 23%) patients were slowly improving, 65 were stagnant (58%) and 22 (19%) were deteriorating. Just under three-quarters (74%) of the wounds had suspected biofilm (criteria including failure of a wound to heal, lack of response to topical and systemic antimicrobial agents, or the presence of slimy substances on the wound surface). Following the evaluations, the average wound closure achieved for all wounds was 72.6%, 19 (17%) wounds healed, 47 (42%) achieved at least 90% wound closure, and 71 (63%) achieved at least 75% closure. The average treatment period was 4.1 weeks; 35 wounds were treated with the dressing for more than 4 weeks. Cost analysis indicated that potential antimicrobial dressing cost reductions of approximately 30% were realised using the NGAD. Conclusion: This real-life, non-randomised evaluation provides encouraging evidence that the NGAD may have a role to play in facilitating wound progression towards healing by helping to eliminate the biofilm barrier. [PUBLICATION] 45 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 8.Title: A systematic review of economic evaluations assessing interventions aimed at preventing or treating pressure ulcers Citation: International Journal of Nursing Studies, Mar 2015, vol. 52, no. 3, p. 769-788, 0020-7489 (March 2015) Author(s): Palfreyman, Simon J, Stone, Patricia W Abstract: Pressure ulcers have an adverse impact on patients and also result in additional costs and workload for healthcare providers. Interventions to prevent pressure ulcers are focused on identifying at risk patients and using systems such as mattresses and turning to relieve pressure. Treatments for pressure ulcers are directed towards promoting wound healing and symptom relief. Both prevention and treatments have associated costs for healthcare providers. The aim of this study was to systematically review the economic evidence for prevention and treatment interventions for pressure ulcers. A systematic review of comparative clinical studies that evaluate interventions to either prevent or treat pressure ulcers. Searches of the major electronic databases were conducted to identify citations that reported costs or economic analysis for interventions directed towards prevention or treatment of pressure ulcers. Only comparative clinical studies were included. Review articles, case-series, non-randomised studies, and studies in a foreign language that did not have an abstract in English were excluded from the review. Decisions regarding inclusion or exclusion were based on a consensus of the authors after review of the title or abstract. Potential citations were obtained for more detailed review and assessed against the inclusion criteria. The studies identified for inclusion were assessed against the 24 key criteria contained in the CHEERS checklist. Costs were standardised to US dollars and adjusted for inflation to 2012 rates. The searches identified 105 potential studies. After review of the citations a total of 23 studies were included: 12 examined prevention interventions and 11 treatments. Review against the CHEERS criteria showed that the majority of included trials had poor reporting and a lack of detail regarding how costs were calculated. Few studies reported more than aggregate costs of treatments with only a small number reporting unit cost outcomes. Existing evidence was poor in regard to the economic evaluation of interventions for the prevention and treatment of pressure ulcers. Much of the published literature had poor reporting quality when compared to guidelines which provide key criteria for studies to adequately examine costs within an economic analysis. [PUBLICATION] 63 references Source: BNI 9.Title: A topical haemoglobin spray for oxygenating pressure ulcers: a pilot study Citation: British Journal of Community Nursing, Mar 2015, vol. 20, no. 3, p. S12., 1462-4753 (March 2015) Author(s): Tickle, Joy Abstract: The effect of pressure ulcers on patient quality of life have been recognised as a real problem for many years, and the need for robust and effective management of pressure ulcers is now a prominent national health-care issue. Myriad different interventions exist for the treatment of pressure ulcers, including clinically effective dressings and pressure-relieving devices, yet many pressure ulcers still do not heal and often become a chronic wound. This is the second of a series of articles (Norris, 2014) discussing the clinical evaluation of a topical oxygen therapy in practice. It describes a small evaluation involving 18 patients with pressure ulcers. The study set out to determine the effect of a topical oxygen therapy on wound size. The therapy comprises a canister that sprays pure haemoglobin in a water solution into or onto the wound. The haemoglobin spray needs to be used at least once every 3 days, does not require training on its use and can be used in any care setting. Overall, results identified wound healing progression in all 18 wounds and wound size reduction in 17 of the 18 wounds. [PUBLICATION] 20 references Source: BNI Full text: Available British Journal of Community Nursing at British Journal of Community Nursing 10.Title: An evaluation of short-stretch compression systems for chronic lower-limb leg ulcers Citation: British Journal of Community Nursing, Mar 2015, vol. 20, no. 3, p. S38., 1462-4753 (March 2015) Author(s): Carr, Caryn, Shadwell, Janice, Regan, Pip, Hammett, Susan Abstract: An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria included patients with untreated peripheral disease, ankle-brachial pressure index (ABPI) Source: BNI Full text: Available British Journal of Community Nursing at British Journal of Community Nursing An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria included patients with untreated peripheral disease, ankle-brachial pressure index (ABPI) Source: BNI Full text: Available British Journal of Community Nursing at British Journal of Community Nursing 11.Title: An overview of polyurethane foams in higher specification foam mattresses Citation: Ostomy Wound Management, Feb 2015, vol. 61, no. 2, p. 38-46, 0889-5899 (February 2015) Author(s): Soppi, Sa, Lehtiö, Juha, Saarinen, Hannu Abstract: Soft polyurethane foams exist in thousands of grades and constitute essential components of hospital mattresses. For pressure ulcer prevention, the ability of foams to control the immersion and envelopment of patients is essential. Higher specification foam mattresses (ie, foam mattresses that relieve pressure via optimum patient immersion and envelopment while enabling patient position changes) are claimed to be more effective for preventing pressure ulcers than standard mattresses. Foam grade evaluations should include resiliency, density, hardness, indentation force/load deflection, progressive hardness, tensile strength, and elongation along with essential criteria for higher specification foam mattresses. Patient-specific requirements may include optimal control of patient immersion and envelopment. Mattress cover characteristics should include breathability, impermeability to fluids, and fire safety and not affect mattress function. Additional determinations such as hardness are assessed according to the guidelines of the American Society for Testing and Materials and the International Organization for Standardization. At this time, no single foam grade provides an optimal combination of the above key requirements, but the literature suggests a combination of at least 2 foams may create an optimal higher specification foam mattress for pressure ulcer prevention. Future research and the development of product specification accuracy standards are needed to help clinicians make evidence-based decisions about mattress use. [Publication] 50 references Source: BNI 12.Title: Antibiofilm efficacy evaluation of a bioelectric dressing in monoand multi-species biofilms Citation: Journal of Wound Care, Feb 2015, vol. 24, no. 2, p. S10., 0969-0700 (February 2015) Author(s): Kim, H., Izadjoo, M.J. Abstract: Objective: Chronic infections are often related to the formation of single or polymicrobial biofilms, which lead to hard-to-treat infections, difficult wound management, and recurrent infections. In this study, we evaluated in vitro antibiofilm properties of a silver and zinc bioelectric dressing (Procellera). Method: We customised and established a poloxamer biofilm model using glass coverslips for the efficacy evaluation of the bioelectric dressing. For antimicrobial susceptibility testing, each bacterial pathogen was diluted to 105CFUs/ml, mixed with 30% poloxamer hydrogels and dropped onto round glass coverslips (25mm diameter) as an abiotic support. Additionally, we mixed four bacterial strains and developed multi-species biofilms in the poloxamer model to examine anti-biofilm efficacy testing against polymicrobial biofilms. Results: After 24 hours incubation, we observed significant inhibition of bacterial growth in nine pathogens (~2or 3-fold log10 reduction) compared to controls (no treatment, gauze, and blank polyester with no silver and zinc). The smallest effect was seen with Enterococcus faecalis strain where there was approximately a 1-fold log10 reduction of microbial growth. The antibiofilm efficacy against multi-species (four pathogens) biofilms, evaluated on chromogenic agar plates, was 1or 2-fold log10 reduction compared to controls. Conclusion: This poloxamer biofilm model was easy to set up, simple to apply, and demonstrated appropriate biofilm formation. The data showed the formation of biofilms inoculated with either single or polymicrobial bacteria under no shear condition, and the bioelectric dressing tested in this study showed effective antibiofilm activity against both the monoand multi-species biofilms. [PUBLICATION] 21 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 13.Title: Association of Sociodemographic Factors with Hope for Cure, Religiosity, and Spirituality in Patients with Venous Ulcers Citation: Advances in Skin and Wound Care, Feb 2015, vol. 28, no. 2, p. 76-82, 1527-7941 (February 2015) Author(s): Salomé, Geraldo Magela, de Almeida, Sergio Aguinaldo, Ferreira, Lydia Masako Abstract: Salome et al evaluate the association of sociodemographic factors with hope for cure and levels of religiosity and spirituality in patients with venous leg ulcers (VLUs). The results shows that most patients with VLUs had low levels of spirituality, did not perceive divine intervention in their daily Die or practice religious activities such as prayer, and had moderate hope for cure. [PUBLICATION] 51 references Source: BNI 14.Title: Biofilm in wound care Citation: British Journal of Community Nursing, Mar 2015, vol. 20, no. 3, p. S6., 1462-4753 (March 2015) Author(s): Rajpaul, Kumal Abstract: A biofilm can be described as a microbial colony encased in a polysaccharide matrix which can become attached to a wound surface. This can affect the healing potential of chronic wounds due to the production of destructive enzymes and toxins which can promote a chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged hospitalisation for some patients. There appears to be a correlation between biofilms and non-healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of wounds. They are a complex concept to diagnose and management needs to be multifactorial. [PUBLICATION] 28 references Source: BNI Full text: Available British Journal of Community Nursing at British Journal of Community Nursing 15.Title: Changes in Classifications of Chronic Lower-Limb Wound Codes in Patients with Diabetes: ICD-9-CM Versus ICD10-CM Citation: Advances in Skin and Wound Care, Feb 2015, vol. 28, no. 2, p. 84-92, 1527-7941 (February 2015) Author(s): Lowe, Jeanne R, Raugi, Greg, Reiber, Gayle E, Whitney, JoAnne D Abstract: Lowe et al determine the sensitivity and specificity of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) and ICD-10-CM codes for individuals with diabetes and foot ulcers. The ICD-9 and ICD-10 are similar for data capture on health history variables, but wound variables are captured more accurately using ICD-10. The increased specificity of ICD-10 for ulcer location and severity improves identification and tracking ulcers during an episode of care. [PUBLICATION] 16 references Source: BNI 16.Title: Clinical audit of a lymphoedema bandaging system: a foam roll and cohesive short stretch bandages Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 83-94, 0969-0700 (March 2015) Author(s): Whitaker, J., Williams, A., Pope, D., Elwell, R., Thomas, M., Charles, H., Muldoon, J. Abstract: Objective: Late-stage lymphoedema is characterised by chronic swelling, shape distortion, inflammatory processes and tissue fibrosis. Our aim was to perform a clinical audit of a lymphoedema compression bandaging system (Rosidal Soft foam roll layer and figure-of-eight application of Actico cohesive inelastic bandages) specifically designed for patients with late stage lower limb lymphoedema. Method: The audit explored suitability of the bandaging system, benchmarking limb volume changes with research evidence, and reporting patient and practitioner evaluations. Results: A mean reduction (33%) in excess limb volume was reported for the 11 patients with unilateral lymphoedema who completed a course of bandaging over 12 days. Mean percentage reduction of absolute limb volume after treatment was 8%. Patient and practitioner evaluations indicated the suitability of this bandage system for patients with late stage lymphoedema in terms of comfort and effectiveness. Conclusion: The bandaging system is suitable for patients with late stage chronic swelling. Two parameters for calculating change in limb volume are not interchangeable. Future evaluation of the bandaging system, using validated outcome measures within a comprehensive research study is required. [PUBLICATION] 14 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 17.Title: Community nurses' judgement for the management of venous leg ulceration: A judgement analysis Citation: International Journal of Nursing Studies, Jan 2015, vol. 52, no. 1, p. 345-354, 0020-7489 (January 2015) Author(s): Adderley, Una J, Thompson, Carl Abstract: Nurses caring for the large numbers of people with leg ulceration play a key role in promoting quality in health via their diagnostic and treatment clinical judgements. In the UK, audit evidence suggests that the quality of these judgements is often sub optimal. Misdiagnosis and incorrect treatment choices are likely to affect healing rates, patients' quality of life, patient safety and healthcare costs. To explore the diagnostic judgements and treatment choices of UK community nurses managing venous leg ulceration. A judgement analysis based on Brunswik's psychological Lens Model theory. UK community and primary care nursing services. 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. During 2011 and 2012, 36 nurses made diagnostic judgements and treatment choices in response to 110 clinical scenarios. Scenarios were generated from real patient cases and presented online using text and wound photographs. The consensus judgements of a panel of nurses with advanced knowledge of leg ulceration judged the same scenarios and provided a standard against which to compare the participants. Correlations and logistic regression models were constructed to generate various indices of judgement and decision "performance": accuracy (Ra), consistency (Rs) and information use (G) and uncertainty (Re). Taking uncertainty into account, nurses could theoretically have achieved a diagnostic level of accuracy of 0.63 but the nurses only achieved an accuracy of 0.48. For the treatment judgement (whether applying high compression was warranted) nurses could have achieved an accuracy of 0.88 but achieved only an accuracy of 0.49. This may have been due to the nurses giving insufficient weight to the diagnostic cues of medical history and appearance of the leg and ulcer and insufficient weight to the treatment cues of type of leg ulcer and pain. Clinical judgements and decisions made by nurses managing leg ulceration are complex and uncertain and some of the variability in judgements and choices can be explained by the ways in which nurses process the information and handle the uncertainties, present in clinical encounters. [PUBLICATION] 59 references Source: BNI 18.Title: Comparative study of two antimicrobial dressings in infected leg ulcers: a pilot study Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 121-127, 0969-0700 (March 2015) Author(s): Mosti, G., Magliaro, A., Mattaliano, V., Picerni, P., Angelotti, N. Abstract: Objective: The aim of the study was to compare the efficacy of a microorganism-binding (MB) dressing with a silver-containing hydrofiber (SCH) dressing in controlling the bacterial loads of heavily colonised or locally infected chronic venous leg ulcers, before surgical management with homologous skin grafts. Method: A randomised comparative single centre study recruited patients presenting with hard-to-heal critically colonised or locally infected leg ulcers, who could be treated with skin grafting. Inclusion criteria included; ulcers of vascular aetiology, over 18 years old, a wound duration =6 months and ankle brachial index (ABPI) >0.6. Patients were randomly assigned to treatment with SCH dressings (Aquacel Ag) or MB dressing (Cutimed Sorbact). Dressings were changed daily over a four-day observation period, after which they were taken for a skin grafting procedure. Swab samples from ulcer beds were taken in order to quantify the bacterial load at inclusion (D0) and at the end of the observation period day 4 (D4). No antibiotics were administered before or during the evaluation period. Results: Both groups (n=20 SCH, n=20 MB) were similar in gender, age, pathophysiology (both had 15 patients with venous leg ulcers and 5 with arterial leg ulcers), ulcer surface, ulcer duration, treatment-related pain and initial bacterial load. Analysing bacterial load variation showed a significant reduction of bacterial burden at D4 in both groups. In the SCH group, we found an average bacterial load reduction of 41.6%, with an average reduction of 73.1% in the MB group (p Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 19.Title: Comparison of Standardized Clinical Evaluation of Wounds Using Ruler Length by Width and Scout Length by Width Measure and Scout Perimeter Trace Citation: Advances in Skin and Wound Care, Mar 2015, vol. 28, no. 3, p. 116-121, 1527-7941 (March 2015) Author(s): Langemo, Diane, Spahn, James, Spahn, Thomas, Pinnamanemi, V Chowdry Abstract: The study objective was to examine precision in wound measurement using a recently Food and Drug Administration-approved Scout (WoundVision, LLC, Indianapolis, Indiana) device to measure wound length (L) and width (W). Wound perimeter and a ruler measurement of L and W were also made. Images of 40 actual patient wounds were measured using the Scout device. All 3 techniques (length, width, perimeter) demonstrated acceptable within and between reader precision; however, the best precision was in wound perimeter measurement. [PUBLICATION] 14 references Source: BNI 20.Title: Comparison of lipidocolloid and chlorhexidine-impregnated tulle gras dressings following microscopically controlled surgery Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 135-138, 0969-0700 (March 2015) Author(s): Hessam, S., Georgas, D., Sand, M., Kassa, T., Bruns, N., Bechara, F.G. Abstract: Objective: Modified microscopically controlled surgery (MCS) is a staged and margin-controlled excision; after MCS, the selection of an appropriate initial wound dressing plays an important role in wound healing. A wide range of dressings is available for temporary wound coverage; however, data comparing different types of wound dressings after MCS are lacking. The aim of this study was to compare two commonly used and commercially available types of wound dressings. Method: We assessed pain levels, wound adherence, bleeding upon dressing removal and signs of infection, with chlorhexidine-impregnated tulle gras and a lipidocolloid dressing used for primary wound dressing following MCS. Results: A total of 42 patients were included. Adherence of the dressing to the wound (p Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 21.Title: Dehydrated human amnion/chorion tissue in difficult-to-heal DFUs: a case series Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 104-111, 0969-0700 (March 2015) Author(s): Penny, H., Rifkah, M., Weaver, A., Zaki, P., Young, A., Meloy, G., Flores, R. Abstract: Diabetic foot ulcers (DFUs) occur as a result of multifactorial complications and are commonly found in the diabetic community. Underlying disease states such as neuropathy and peripheral vascular disease can slow healing rates, potentially leading to recurrence, amputation, and increased mortality. As with many other disease processes, DFUs have several treatment options, such as debriding agents, alginate seaweed extract, hydrocolloid gels, and amniotic membrane allografts. The presented cases all used a dehydrated human amniotic/chorionic membrane allograft (dHACM; EpiFix) to aid the healing process. Human amniotic epithelial membranes have seen increased usage due to their ability to enhance the healing process and accelerate cellular regeneration. The DFUs healed in all of the five patients treated, and patients saw a full recovery in 2.5-11 weeks. In addition, the healing time decreased in spite of the non-adherence seen in three of the patients. These results suggest another possible use for dHACM; however, further studies are required to confirm these data. [PUBLICATION] 12 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 22.Title: Diagnostic and treatment decision making in community nurses faced with a patient with possible venous leg ulceration: A signal detection analysis Citation: International Journal of Nursing Studies, Jan 2015, vol. 52, no. 1, p. 325-333, 0020-7489 (January 2015) Author(s): Thompson, Carl, Adderley, Una Abstract: Judgements and decisions about venous leg ulcer management are characterised by uncertainty. Good judgements and reduced variations in practice require nurses to identify relevant "signals" in clinical encounters. Nurses, even experienced ones, vary in their ability to separate these signals from surrounding noise. Examine specialist and generalist nurses' discrimination of clinical signals and noise when (i) diagnosing venous versus other causes leg ulceration, and (ii) starting multilayer compression therapy. A signal detection analysis within a cross sectional survey. Four English NHS districts. Tissue viability specialist (n = 18) and generalist (district and practice nurses, n = 18) sampled from networks of nurses caring for people with leg ulcers. Mean age was 46 years, 78% had more than 10 years nursing experience. They worked on average 32.5 h per week, of which 10 h were spent caring for people with leg ulcers. 110 clinical scenarios based on anonymous patient data from a large clinical trial of compression therapy for leg ulceration. The scenarios were classed as either signal (venous leg ulcer present and/or compression therapy warranted, n = 57) or no signal cases (other kind of ulcer and/or compression therapy contraindicated, n = 53) by four experts. Nurses made diagnostic and treatment judgements for each scenario. A signal detection analysis was undertaken for each nurse. Measures of signal detection (d Judgements and decisions about venous leg ulcer management are characterised by uncertainty. Good judgements and reduced variations in practice require nurses to identify relevant "signals" in clinical encounters. Nurses, even experienced ones, vary in their ability to separate these signals from surrounding noise. Examine specialist and generalist nurses' discrimination of clinical signals and noise when (i) diagnosing venous versus other causes leg ulceration, and (ii) starting multilayer compression therapy. A signal detection analysis within a cross sectional survey. Four English NHS districts. Tissue viability specialist (n = 18) and generalist (district and practice nurses, n = 18) sampled from networks of nurses caring for people with leg ulcers. Mean age was 46 years, 78% had more than 10 years nursing experience. They worked on average 32.5 h per week, of which 10 h were spent caring for people with leg ulcers. 110 clinical scenarios based on anonymous patient data from a large clinical trial of compression therapy for leg ulceration. The scenarios were classed as either signal (venous leg ulcer present and/or compression therapy warranted, n = 57) or no signal cases (other kind of ulcer and/or compression therapy contraindicated, n = 53) by four experts. Nurses made diagnostic and treatment judgements for each scenario. A signal detection analysis was undertaken for each nurse. Measures of signal detection (d prime or d') and judgement tendency or bias (C) were computed. Differences between specialist and generalist nurses were tested for using the Mann Whitney U test and graphically explored using Receiver Operating Curves (ROC). Specialists identified more true positive cases than the generalist nurses: 75% vs. 59% for the diagnostic judgement (p 0.01) and 70% vs. 60% for the treatment judgement. They were significantly more sensitive to the signals present (d' 1.68 vs. 1.08 for the diagnostic judgement and 1.62 vs. 1.11 for the treatment judgement). Specialists exhibited a significantly higher bias towards initiating treatment (C = .81 vs. .56, p 0.01) but this did not extend to their diagnostic judgements. Specialists also varied slightly less in their signal detection abilities. Nurse specialism was associated with better, but still variable, clinical diagnostic and treatment signal detection in simulated venous leg ulcer management. [PUBLICATION] 59 references Source: BNI 23.Title: Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds Citation: Journal of Wound Care, Jan 2015, vol. 24, no. 1, p. 5-10, 0969-0700 (January 2015) Author(s): Kumara, D.U.A., Fernando, S.S.N., Kottahachchi, J., Dissanayake, D.M.B.T., Athukorala, G.I.D.D.A.D., Chandrasiri, N.S., Damayanthi, K.W.N., Hemarathne, M.H.S.L., Pathirana, A.A. Abstract: Objective: Antiseptics are widely used in wound management to prevent or treat wound infections due to their proven wound healing properties regardless of their cytotoxicity. The objective of this study was to determine the bactericidal effects of three antiseptics on pathogens known to cause wound infections. Method: The study was carried out at a tertiary care hospital and a university microbiology laboratory in Sri Lanka in 2013. The three acids (acetic acid, ascorbic acid and boric acid) in increasing concentration (0.5%, 0.75% and 1%) were tested against bacterial suspensions equivalent to 0.5 McFarland standard. The Bacteria isolates used were isolated from wound and standard strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Results: There were 33 (68.8%) Coliforms, 10 (20.8%) Pseudomonas species, and 5 (10.4%) strains of Staphylococcus aureus. Acetic acid at concentration of 0.5% inhibited growth of 37 (77%) and 42 (87.5%) of tested isolates when exposed for 30 and 60 minutes, respectively. However 100% inhibition was achieved at four hours. At a concentration of 0.75%, 40 (83.3%) and 44 (91.7%) were inhibited when exposed for 30 and 60 minutes, respectively, with 100% inhibition at 4 hours. At concentration of 1%, 46 (95.8%) inhibition was seen at 30 minutes and 100% inhibition at 60 minutes. Ascorbic acid, at 0.5% and 0.75 % concentrations, inhibited growth of 45(93.7%) and 47(97.9%) of isolates respectively when exposed for 30 minutes. At these two concentrations, 100% inhibition was achieved when exposed for one hour. At 1% concentration, 100% inhibition was achieved at 30 minutes. Boric acid did not show bactericidal effect at concentrations of 0.5%, 0.75 % and 1%. Pseudomonas species were inhibited at 30 minutes by 0.5% acetic acid. Bactericidal effect against all the standard strains was seen with three acids at each concentration tested from 30 minutes onwards. Conclusion: Ascorbic acid was bactericidal for all organisms tested within the shortest exposure time at the lowest concentration compared to other two acids. Despite promising bactericidal effects, further studies warrant, as ongoing debates on toxicity of acids on tissue epithelialisation. Application of antiseptics for a shorter duration could overcome this problem without losing bactericidal activity. [PUBLICATION] 18 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 24.Title: Evaluation of the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers: a systematic review and documentary analysis Citation: Journal of Clinical Nursing, Feb 2015, vol. 24, no. 3-4, p. 536-545, 0962-1067 (February 2015) Author(s): McGraw, Caroline, Drennan, Vari M Abstract: To evaluate the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers. The objective was to identify the extent to which these frameworks take account of the setting where the ulcer originated as being the person's home rather than a hospital setting. Pressure ulcers involving full-thickness skin loss are increasingly being regarded as indicators of nursing patient safety failure, requiring investigation using root cause analysis frameworks. Evidence suggests that root cause analysis frameworks developed in hospital settings ignore the unique dimensions of risk in home healthcare settings. A systematic literature review and documentary analysis of frameworks used to investigate community-acquired grade three and four pressure ulcers by home nursing services in England. No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of communityacquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home. This study provides evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose. [PUBLICATION] 38 references Source: BNI 25.Title: Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study Citation: American Journal of Critical Care, Jan 2015, vol. 24, no. 1, p. 57-66, 1062-3264 (January 2015) Author(s): Dykeman, Marilyn Schallo;, Betsy, Metheny, Norma, Kirby, John, Pierce, Janet Abstract: Background Guidelines recommending head of bed (HOB) elevation greater than 30o to prevent ventilatorassociated pneumonia conflict with guidelines to prevent pressure ulcers, which recommend HOB elevation less than 30o. Objectives To examine the feasibility of 45o HOB elevation and describe and compare the occurrence of reflux, aspiration, and pressure ulcer development at 30o and 45o HOB elevation. Methods A randomized 2-day crossover trial was conducted. HOB angle was measured every 30 seconds. Oral and tracheal secretions were analyzed for pepsin presence. Skin was assessed for pressure ulcers. Wilcoxon signed rank tests and Kendall t correlations were conducted. Results Fifteen patients were enrolled; 11 completed both days. Patients were maintained at 30o (mean, 30o) for 96% of minutes and at 45o (mean, 39o) for 77% of minutes. No patients showed signs of pressure ulcers. A total of 188 oral secretions were obtained, 82 (44%) were pepsin-positive; 174 tracheal secretions were obtained, 108 (62%) were pepsin-positive. The median percentage of pepsin-positive oral secretions was not significantly higher (P = .11) at 30o elevation (54%) than at 45o elevation (20%). The median percentage of pepsin-positive tracheal secretions was not significantly higher (P = .37) at 30o elevation (71%) than 45o elevation (67%). Deeper sedation correlated with increased reflux (P = .03). Conclusions HOB elevation greater than 30o is feasible and preferred to 30o for reducing oral secretion volume, reflux, and aspiration without pressure ulcer development in gastric-fed patients receiving mechanical ventilation. More deeply sedated patients may benefit from higher HOB elevations. [PUBLICATION] Source: BNI Full text: Available American journal of critical care : an official publication, American Association of Critical-Care Nurses at American Journal of Critical Care 26.Title: Human acellular dermal wound matrix for treatment of DFU: literature review and analysis Citation: Journal of Wound Care, Mar 2015, vol. 24, no. 3, p. 128-134, 0969-0700 (March 2015) Author(s): Reyzelman, A.M., Bazarov, I. Abstract: Diabetic foot ulcers (DFUs) affect a significant number of people and the treatment is challenging and costly. Since only a small portion of patients respond to standard care, the majority require more advanced wound healing interventions. Human acellular dermal matrices regenerative tissue matrices derived from human tissue and processed from screened donated skin can aid wound closure by restoring the missing physiological factors to the microenvironment. A literature review of the clinical literature was performed to estimate the comparative effectiveness of one specific human acellular dermal wound matrix (HADWM; Graftjacket regenerative tissue matrix) versus standard care in healing DFUs. Outcomes from three prospective, controlled clinical trials, which included 154 patients with DFUs, were pooled. A comparative analysis revealed a statistically significant reduction in mean wound healing time, 1.7 weeks, as well as a nearly four-fold improvement in the chance of healing ulcers treated with HADWM versus moist wound-care. These pooled results suggest that HADWM may improve healing outcomes for these difficult-to-heal lower extremity wounds. [PUBLICATION] 43 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 27.Title: Infrared Skin Thermometry: An Underutilize Cost-effective Tool for Routine Wound Care Practice and Patient High-Risk Diabetic Foot Self-monitoring Citation: Advances in Skin and Wound Care, Jan 2015, vol. 28, no. 1, p. 37-44, 1527-7941 (January 2015) Author(s): Sibbald, R Gary, Mufti, Asfandyar, Armstrong, David G Abstract: The aim of this article is to provide practitioners with an overview of infrared skin thermometry for everyday wound care practice. Thermometers have the potential for home use by patients with neuropathy to self-detect damage from repetitive trauma that will increase the risk of foot ulceration. [PUBLICATION] 37 references Source: BNI 28.Title: Is depression a risk factor for diabetic foot ulcers? 11-years follow-up of the Nord-Trøndelag Health Study (HUNT) Citation: Journal of Diabetes and its Complications, Jan 2015, vol. 29, no. 1, p. 20-25, 1056-8727 (January 2015) Author(s): Iversen, Marjolein M, Tell, Grethe S, Espehaug, Birgitte, Midthjell, Kristian, Graue, Marit, Rokne, Berit, Berge, Line Iden, Østbye, Truls Abstract: Aim: To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer. Methods: The Nord-Trøndelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995-97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006-08) (n=36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU. Results: Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score>=8 at baseline (OR 1.30 95% CI, 1.07-1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR=1.95 95% CI, 1.02-3.74) for those reporting a HADS-D score of 8-10, and 3-fold (OR=3.06 95% CI, 1.24-7.54) for HADS-D scores>=11, compared to HADS-D scores Source: BNI Full text: Available Journal of diabetes and its complications at Journal of Diabetes and its Complications 29.Title: Measurement of microelectric potentials in a bioelectrically-active wound care device in the presence of bacteria Citation: Journal of Wound Care, Jan 2015, vol. 24, no. 1, p. 23-33, 0969-0700 (January 2015) Author(s): Park, S.S., Kim, H., Makin, I.R.S., Skiba, J.B., Izadjoo, M.J. Abstract: Objective: Wound healing is enhanced in the presence of an external electrical field. The purpose of this study was first to investigate whether microelectric potentials (EPs) can be generated when the innovative design of a silver (Ag)and zinc (Zn)-printed wound care device was exposed to saline solution which is commonly used to clean wound sites; and second to measure the generated EPs while the device was exposed to bacterial culture suspensions to mimic infection. Method: An Ag/Zn-printed test specimen as a wound care device was designed to accommodate Ag and Zn halfcell potentials by alternatively printing them on a woven polyester material in a well-characterised dot matrix pattern. A well-calibrated high impedance EPs measuring system was used to measure any EPs generated. Ultrasensitive inductively coupled plasma analysis was performed to determine whether the device induced any increase in trace metals in rabbit blood following implantation for 2-4 weeks. Results: EPs were consistently generated under various conductive solutions at the levels of 120.4±26.3mV (average±standard deviation) on Ag dots and -506.5±76.3mV over Zn dots to form microcircuits with EPs of 626.7±86.3mV between the Ag and Zn metallic elements of the dressing. Interestingly, the patterns of EPs generated with stable polarities were consistent when the device was exposed to bacterial suspensions for mimicking wound infection. Implantation of the device did not cause any increase in Ag or Zn in rabbit blood. Conclusion: The Ag/Zn-printed wound device generated sustained EPs successfully in the presence of various conductive fluids without changing EPs including polarities. Consistently generated EPs at each battery couple with Ag/Zn-based wound device would restore disrupted physiologic bioelectric signals on wound sites, which could lead to improved wound healing. [PUBLICATION] 47 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 30.Title: Palliative Wound Care Management Strategies for Palliative Patients and Their Circles of Care Citation: Advances in Skin and Wound Care, Mar 2015, vol. 28, no. 3, p. 130-140, 1527-7941 (March 2015) Author(s): Woo, Kevin Y, Krasner, Diane L, Kennedy, Bruce, Wardle, David, Moir, Olivia Abstract: The principles of palliative wound care should be integrated along the continuum of wound care to address the whole person care needs of palliative patients and their circles of care, which includes members of the patient unit including family, significant others, caregivers, and other healthcare professionals that may be external to the current interprofessional team. Palliative patients often present with chronic debilitating diseases, advanced diseases associated with major organ failure (renal, hepatic, pulmonary, or cardiac), profound dementia, complex psychosocial issues, diminished self-care abilities, and challenging wound-related symptoms. This article introduces key concepts and strategies for palliative wound care that are essential for interprofessional team members to incorporate in clinical practice when caring for palliative patients with wounds and their circles of care. [PUBLICATION] 81 references Source: BNI 31.Title: Physical activity levels and torso orientations of hospitalized patients at risk of developing a pressure injury: An observational study Citation: International Journal of Nursing Practice, Feb 2015, vol. 21, no. 1, p. 11-17, 1322-7114 (February 2015) Author(s): Chaboyer, Wendy, Mills, Peter M, Roberts, Shelley, Latimer, Sharon Abstract: Pressure injury guidelines recommend regular repositioning yet patients' mobility and repositioning patterns are unknown. An observational study using activity monitors was undertaken to describe the 24h activity patterns of 84 hospitalized patients at risk of developing a pressure injury. The vast majority of participants' time was spent in the sedentary activity range (94%±3%) followed by the light range (5%±4 %). Patients changed their posture a median of 94 (interquartile range 48) time in the 24-h period (range 11-154), or [asymptotically =]3.8 times per hour. Although a main focus for pressure injury prevention has been on repositioning, this study shows that patients with restricted mobility are actually moving quite often. Therefore, it might be appropriate to focus more attention on other pressure injury prevention strategies such as adequate nutrition, appropriate support surfaces and good skin care. [Publication] 42 references Source: BNI 32.Title: Preventing pressure ulcers in patients in intensive care Citation: Nursing Standard, Feb 2015, vol. 29, no. 26, p. 53-61, 0029-6570 (February 25, 2015) Author(s): Gage, William Abstract: This article discusses the prevention and management of pressure ulcers in intensive care. It outlines a service improvement project conducted in the intensive care units at Imperial College Healthcare NHS Trust with the aim of reducing the incidence of hospital-acquired pressure ulcers. The project introduced a set of 'essential standards' and an audit tool to monitor compliance. Implementation of the essential standards resulted in a reduction in the total number of pressure ulcers acquired in the four intensive care units, with an absence of any category 3 or 4 pressure ulcers (the most severe categories of pressure ulcer). The article describes the measures taken to ensure the sustainability and spread of the initiative within the NHS trust. [PUBLICATION] 23 references