Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

Study objective: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.

Design: Prospective, randomized controlled trial.

Setting: Major metropolitan, academically affiliated, tertiary referral center.

Patients: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure.

Results: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001).

Conclusions: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.

Risky business: stories from the field of rural community nurses' work in domestic violence.

This paper reports on a descriptive study into family violence in rural Victoria. Focus groups were held in a number of areas across rural Victoria with a total of 24 community nurse participants. The focus groups were audio-taped and the tapes transcribed to enable the clustering of themes. The dominant themes were: picking up cues, helping and helplessness, holding secrets and quiet resistance. Underpinning all these themes however, was the notion of 'risky business'. All nurses in the study gave examples of situations that they encountered; their ways of helping; of working sensitively; of working around a system that is unhelpful; and the ways in which their work while skilled, thoughtful and wise, is also costly in terms of the emotional wounds they carry. Rural nurses work with considerable risk and courage as they engage in the care and support of women experiencing family violence.

Emergency nurse practitioner care and emergency department patient flow: case-control study

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods: A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Caring for the wounded healer - nurturing the self

Health professionals have to deal with a “wounded society”, for example, violence, natural disasters and displaced people. Shortage of health professional groups and the high use of complementary therapies may reflect professional wounds, such as stress and burnout. Self-care is an important aspect of health professionals’ lives, given modern-day work stressors that can affect an individual's physical, mental and spiritual health. Often people become healers through personal suffering. Each person wounded or not, needs to understand his or her own need to be nurtured, and develop and implement a self-care health programme. Personal and professional reflection are important to understanding the nature of events that lead to “wounds” and how they can be transcended and the experiences used in holistic care. Aromatherapy can be a useful addition to self-care especially in managing stress and minor self-limiting conditions.

Metamemory training for memory disorders in adults with a closed head injury

The purpose of the present study was to investigate the efficacy of a memory and metamemory training program on memory performance and metamemory judgement accuracy in adults with a closed head injury. A multiple baseline across subjects design was used with six subjects. All subjects were seen at least two years post-injury. Training included general metamemory information about the nature of memory, use of a specific memory strategy to assist verbal recall (to Preview, Question, Read, State and Test- PQRST), specific metamemory information about the strategy, and a self instruction procedure (WTSC- What is the task, Select a strategy to use, Try out strategy, Check to evaluate strategy effectiveness). During the training period all subjects recalled greater than fifty percent of paragraph ideas while using PQRST. Follow-up tests showed that five of the six subjects maintained recall levels but a gradual decrease in slope was observed over eight weeks post-training. Tests of recall, recognition and metamemory judgements on Sentence and Action Tasks were used to evaluate generalisation of training. Two subjects showed improved recall and two subjects showed improved recognition performance. In addition, four subjects demonstrated greater metamemory judgement accuracy about recognition performance following training. Improved performance post-training was also observed for three subjects on the Rivermead Behavioral Memory Test and the Logical Memory subtest of the Wechsler Memory Scale-Revised, greater than that expected for repeated testing. Several factors were identified as having a role in subjects’ ability to benefit from training.

Adiposity and its metabolic consequences contribute to Achilles tendinopathy

Pain in the Achilles tendon commonly affects active individuals but is also seen in sedentary people. This thesis shows that the accumulation of excess body fat, abnormal blood lipids and glucose metabolism were associated with Achilles tendinopathy. Targeting these lifestyle factors may improve treatment outcomes for tendon injury.

Outcome after traumatic injury

The thesis' aim was to explore outcome after traumatic injury. Poorer physical health prior to injury and receipt of compensation explained variance in physical health 12 months after injury. Poorer mental health 3 and 12 months after injury was partly explained by stronger emotional reactions immediately after the injury, receipt of compensation, and lower perceived social support. The portfolio focuses on symptoms of depression and anxiety in those suffering chronic pain. Through four case studies who attended a pain management service, it is argued that psychological symptoms are able to be addressed concurrently with pain management strategies.

Risk factors for Mycobacterium ulcerans infection, southeastern Australia

Buruli/Bairnsdale ulcer (BU) is a severe skin and soft tissue disease caused by Mycobacterium ulcerans. To better understand how BU is acquired, we conducted a case-control study during a sustained outbreak in temperate southeastern Australia. We recruited 49 adult patients with BU and 609 control participants from a newly recognized BU-endemic area in southeastern Australia. Participants were asked about their lifestyle and insect exposure. Odds ratios were calculated by using logistic regression and were adjusted for age and location of residence. Odds of having BU were at least halved for those who frequently used insect repellent, wore long trousers outdoors, and immediately washed minor skin wounds; odds were at least doubled for those who received mosquito bites on the lower legs or lower arms. This study provides new circumstantial evidence that implicates mosquitoes in the transmission of M. ulcerans in southeastern Australia.

Training patterns and negative health outcomes in triathlon : longitudinal observations across a full competitive season

AIM: Despite heavy training requirements, triathlon is a sport that is rapidly increasing in popularity. Yet, there is limited research detailing the relationship between training, the incidence of injuries and illness, psychological stress, overtraining and athlete burnout amongst triathletes. Six hypotheses relating inter-individual differences to training factors were generated to evaluate change in self-reported measures of these negative health outcomes over a training year.

METHODS: Thirty, well-trained, triathletes (males n=20: age=27.1±9.1 years and females n=10: age=27.4±6.6 years) from a local triathlon club participated in this study. The study commenced during pre-season training, and involved weekly monitoring of each athlete until the end of the competitive season 45 weeks later. Linear Mixed Modelling was used for the analysis.

RESULTS: Signs and symptoms of injury and illness (SAS) were significantly associated with increases in training factors (P≤0.05); however, greatest impact on SAS was produced by psychological stressors (P≤0.001). Common symptoms of overtraining were significantly affected by increases in exposure to both training and psychological stressors (P≤0.05). Mood disturbance was not significantly affected by training factors (P>0.05) but rather increases in psychological stressors (P≤0.001). Finally, each of the three athlete burnout subscales were significantly affected by both psychological (P≤0.001) stressors as well as varying combinations of training factors (P≤0.05).

CONCLUSIONS: Exposure to stressors (either training or psychological) had significant effects on all negative health outcomes assessed.

Electrospun nanofibres

This book deals with an emerging nanofibre-making technology, electrospinning, the functionalities of electrospun nanofibres and their wound healing application. An important fundamental issue, fibre morphological evolution during electrospinning, is clarified. Effective techniques to improve the fibre toughness and control the surface wettability of nanofibre membrane have been developed. These functional nanofibre membranes have been used as dressing materials for healing skin wounds, and shown promising results. This work makes electrospun nanofibre membrane an ideal candidate for wound healing application.

Alt.film.au(2) : Blogging at the margins in Australian retrospective 2012

In 1972 Albie Thoms wrote: ‘In Australia it has been impossible to elicit much sympathetic appraisal from critics who seem distressed by the relation of personal film to amateur movies. Even those proselytizing for the New cinema have underrated the personal film as a worthy antidote to the market assumptions of Hollywood.’ (Thoms 1978, p. 146) The question now is, of course, is anything different in 2012? The answer is of course yes and no. Although the politics remains frustratingly familiar the digital has progressed further to the point that where in the 60s every one picked up a guitar, now we pick up a video camera. A postscript relates those films in the program not available for inclusion in the original 90s rant- (i.e. they did not exist) I have further annotated this re-play of old wounds and victories with commentary on some of the films in the screening program.

Wound management in disaster settings

Background Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where resources and facilities are also often limited, and clear appropriate guidance is needed for early wound management. Methods We undertook a systematic review focusing on the nature of wounds in disaster situations, and the outcomes of wound management in recent disasters. We then presented the findings to an international consensus panel with a view to formulating a guideline for the initial management of wounds by first responders and subsequent healthcare personnel as they deploy. Results We included 62 studies in the review that described wound care challenges in a diverse range of disasters, and reported high rates of wound infection with multiple causative organisms. The panel defined a guideline in which the emphasis is on not closing wounds primarily but rather directing efforts toward cleaning, debridement, and dressing wounds in preparation for delayed primary closure, or further exploration and management by skilled surgeons. Conclusion Good wound care in disaster settings, as outlined in this article, can be achieved with relatively simple measures, and have important mortality and morbidity benefits. © 2014 Société Internationale de Chirurgie.