Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-Heal Chronic Venous Leg Ulcers

Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healed ulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (£141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs

Pressure-relieving devices for preventing heel pressure ulcers

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effects of pressure-relieving devices in preventing heel pressure ulcers

A randomised trial to compare the performance of Oxyzyme® and Iodozyme® with standard care in the treatment of patients with venous and mixed venous/arterial ulceration

This study was to evaluate the potential benefits of two products (Oxyzyme® and Iodozyme®) into a leg ulcer service in South Staffordshire, UK. A randomised controlled trial (RCT) was used to evaluate time to ulcer healing, quality of life, pain and cost effectiveness. 100 patients were randomised to receive either Oxyzyme/Iodozyme (active group) or standard care (control group) with venous or mixed arterio-venous ulcers. Patients were evaluated weekly up to 12 weeks, with further follow up at 24 weeks. Whilst there was a small benefit in terms of healing over follow up using the Cox Proportional Hazards Model, this did not achieve a standard level of statistical significance (hazard ratio = 1.13, 95%CI 0.64 to 2.02, p = 0.67) after adjustment for confounding factors. Patients with high protease activity showed an improved and faster healing in the active group, (HR = 1.35, 95%CI 0.63, 2.87) p = 0.44. The active group required significantly fewer dressing changes (14.8 versus 10.0, p = 0.033). Despite the dressing costs being higher, there was a significantly lower cost of nursing time, leading to a greater cost effectiveness in terms of cost per healed ulcer (£977 versus £1071. A Markov model used to assess cost effectiveness in the main trial found that the control group had slightly better outcomes (12 more ulcer free weeks), but at a substantially greater cost (£5031). When those with high protease activity the cost in the active group dominated, with lower cost (−£2450) and an improved outcome (29 more ulcer free weeks). Health related quality of life (HRQoL) and pain significantly improved over the assessment period, though there was no difference between the treatment groups. The use of Oxyzyme® and Iodozyme® could provide better value for money in the management of venous and mixed arterio-venous ulcers than standard care in a community leg ulcer service

Quality control of a medicinal larval (Lucilia sericata) debridement device based on released gelatinase activity

Lucilia sericata Meigen (Diptera: Calliphoridae) larvae are manufactured worldwide for the treatment of chronic wounds. Published research has confirmed that the primary clinical effect of the product, debridement (the degradation of non-viable wound tissue), is accomplished by a range of enzymes released by the larvae during feeding. The quality assessment of larval activity is currently achieved during production using meat-based assays, which monitor insect growth and/or the reduction in substrate mass. To support this, we have developed a complementary radial-diffusion enzymatic assay (RDEA) to produce a visual and measureable indication of the activity of larval alimentary products (LAP) collected under standardised conditions, against a gelatin substrate. Using basic laboratory equipment and reagents, the assay is rapid and suited to high-throughput. Assay reproducibility is high (SD 0.06 - 0.27, CV 0.75 - 4.31%) and the LAP collection procedure does not adversely affect larval survival (mortality < 2%). As a cost- and time-effective method, it is suited to academic or industrial use, supporting good manufacturing (or laboratory) practice (GMP and GLP) as a quality control (QC) assay

Reversible Transparency: A Study of the New Danish Access to Information Act

This article analyses the new Danish Access to Information Act, specifically how it has controversially reduced public access to information when it comes to the most central political decisions. These changes represent an interesting development in a state usually considered an exponent for a high level of transparency in the public sector. We analyse how the Act has made it possible to reject applications for information to be used for ministerial advice and pertaining to documents exchanged between ministers and MPs, and we discuss the introduction of an article enabling the rejection of applications solely on the grounds that they will use considerable administrative resources. A remarkable shift in the approach to access to information has taken place, resulting in diminished public access to the background material for significant political decisions. Pointing out the need for further investigation, we compare this Danish tendency to international standards and pose the question of whether the Danish case is an example of a more general trend towards a reversal in the level of transparency in liberal democracies.<br/

Reversible Transparency: A Study of the New Danish Access to Information Act

This article analyses the new Danish Access to Information Act, specifically how it has controversially reduced public access to information when it comes to the most central political decisions. These changes represent an interesting development in a state usually considered an exponent for a high level of transparency in the public sector. We analyse how the Act has made it possible to reject applications for information to be used for ministerial advice and pertaining to documents exchanged between ministers and MPs, and we discuss the introduction of an article enabling the rejection of applications solely on the grounds that they will use considerable administrative resources. A remarkable shift in the approach to access to information has taken place, resulting in diminished public access to the background material for significant political decisions. Pointing out the need for further investigation, we compare this Danish tendency to international standards and pose the question of whether the Danish case is an example of a more general trend towards a reversal in the level of transparency in liberal democracies.<br/

Reversible Transparency: A Study of the New Danish Access to Information Act

This article analyses the new Danish Access to Information Act, specifically how it has controversially reduced public access to information when it comes to the most central political decisions. These changes represent an interesting development in a state usually considered an exponent for a high level of transparency in the public sector. We analyse how the Act has made it possible to reject applications for information to be used for ministerial advice and pertaining to documents exchanged between ministers and MPs, and we discuss the introduction of an article enabling the rejection of applications solely on the grounds that they will use considerable administrative resources. A remarkable shift in the approach to access to information has taken place, resulting in diminished public access to the background material for significant political decisions. Pointing out the need for further investigation, we compare this Danish tendency to international standards and pose the question of whether the Danish case is an example of a more general trend towards a reversal in the level of transparency in liberal democracies.<br/

Chronic pain in Pachyonychia Congenita:evidence for neuropathic origin

Background: Pachyonychia congenita (PC) is a rare autosomal dominant skin disease with chronic pain being the most prominent complaint. Histological studies showing alterations in sensory innervation along with few reports on alterations in mechanical sensitivity suggest that PC may be a form of neuropathy.Objective: To systematically evaluate sensory function of PC patients vs. controls, here for the first time, in order to investigate PC pathophysiology.Methods: Patients (n=62) and controls (n=45) completed the McGill and Douleur Neuropathique-4 (DN4) questionnaires. Sensory testing included: detection and pain thresholds, pathological sensations, conditioned pain modulation (CPM) and temporal summation of pain (TSP).Results: A moderate-severe chronic pain in the feet, throbbing and stabbing in quality, was highly prevalent among PC patients (86%) and especially debilitating during weight bearing. In addition, the majority of patients had DN4 score ≥4 (62%), static allodynia (55%) and tingling (53%) in the feet. Compared to controls, PC patients exhibited thermal and mechanical hypoesthesia and mechanical hyperalgesia in the feet. CPM was reduced among the patients, and associated with more enhanced feet mechanical hyperalgesia. The specific gene and nature of the causative mutation did not affect any of these features.Conclusion: Although thermal and mechanical hypoesthesia may result from thicker skin, its presentation in painful regions along with mechanical hyperalgesia and allodynia point towards the possibility of neuropathic changes in PC. The clinical features and DN4 scores support this possibility and therefore neuropathic pain medications may be beneficial for PC patients. This article is protected by copyright. All rights reserved.</p