Wound Healing Project: Using wound care as a case study to assess the impact of public policy on healthcare.

Background: Chronic wound care represents a considerable burden to patients and the healthcare system, however often goes unrecognised. Through public policy the government directly impacts public health and the health of individuals with the aim of protecting people from potential health risk factors. Healthcare need assessments are of great importance to public policy makers since they provide a status quo of the health needs of a patient population, at a national or local level. Some authors argue that healthcare needs assessments should be legal requirements of public policy. Aim: To explore the influence of public policy on healthcare using wound care as a case study and to research wound care needs of a local population in Nottinghamshire. Methods: The study adopted a mixed method study design using a concurrent triangulation approach. Conceptually, the study utilised the Healthcare Needs Assessment framework. The qualitative study consisted of qualitative interviews with wound care commissioners, providers and healthcare professionals. The quantitative study involved a point prevalence study of wounds on a community nursing caseload in two Clinical Commissioning Group areas in Nottinghamshire. Data were analysed using constant comparative method and descriptive statistics. Findings: In total, 1,462 patients were assessed as part of the point prevalence study. The quantitative study shows that prevalence of wounds as well as associated conditions is increasing. Thirteen qualitative interviews explored how public policy impacts on community services. The qualitative study demonstrates that community nursing and tissue viability services are facing a lot of challenges caused by changing demographics and the New Public Management reform. Conclusion: Current public policies mean that healthcare providers are required to provide ‘more for less’ while increasing the quality of care. The influence of New Public Management reforms significantly affects community and tissue viability nurses causing a decreased satisfaction and increased workload

Prevalence and risk factors for chronic edema in U.K. community nursing services

Background and study design: Chronic edema (CO) is believed to be a major clinical problem within community nursing services in the UK. This study was undertaken as part of the LIMPRINT international study to determine the number of people with chronic oedema and its impact on health services. Methods and Results: Three urban based community nursing services participated in the UK with prospective evaluation over 4 weeks of all patients receiving nursing care using a questionnaire-based interview and clinical assessment using the LIMPRINT tools. Of the total 2,541 assessed 1,440 (56.7%) were considered to have CO, comprising Leicester City (768/ 1298 (59.2%), Nottingham West (124/ 181 (68.5%)) and Nottingham City (548/1062 (51.6%)). The mean age for women with CO was 78.6 (SD 12.8) years and for men 72.9 (SD14.5). More patients with CO suffered from diabetes (32.1% versus 27.9%, p=0.027), heart failure/ ischaemic heart disease (27.3% versus 14.0%, p<0.001) and peripheral arterial occlusive disease (5.5% versus 1.9%, p<0.001). By far the greatest association was with the presence of a wound (73.6% versus 37.9%, p<0.001). Cellulitis affected 628 (24.7%) and 688 (47.8%) had a concurrent leg ulcer. Rates of reduced mobility (71.6% versus 61.9%) and obesity were higher in those with CO. Six independent factors associated with chronic oedema were service location, age, ethnicity, obesity, heart failure and the presence of a wound. Conclusion: Chronic oedema is a major and growing health care problem within primary care that has been previously unrecognised and requires effective service provision

LIMPRINT: the UK experience - subjective control of swelling in patients attending specialist lymphedema services

Background and study design: This study was undertaken as part of the UK LIMPRINT international study to determine the number of people with chronic oedema and its impact on health services. Overall 7436 with chronic oedema (CO) were recruited in the main UK study from a range of health settings. Methods and results: Subjective control of arm and leg chronic oedema (CO) was defined for patients attending three Lymphoedema services in the UK. Of the total available in the UK dataset 5165 (69.4%)/ 7436(100%) of participants were included. Reasons for exclusions included the following: lack of information (1669), having both arm and leg swelling (272), lack of description of control (5) and professional inability to decide whether CO was controlled (325). Arm swelling occurred in 953 (18.5%), with leg CO in 4212 (81.5%). Poor control was found in 1430 (27.7%) and good control in 3735 (72.3%). Control of arm swelling was worse in men and control increased overall in those aged over 45 years. In contrast control of CO worsened in those with leg CO with increasing age and multiple co-morbidities. Obesity and cellulitis, particularly an episode in the last year were associated with poor control. Independent risk factors for arm CO were obesity, neurological disease and cellulitis in the last year and for leg CO: obesity, poor mobility, heart disease, presence of a wound, cellulitis in the last year and duration of swelling. Conclusion: Control of CO within specialised centres is complex due to sociodemographic and clinical comorbidities

Estimation of the prevalence of lymphoedema/chronic oedema in acute hospital in-patients

Background: To estimate the prevalence of lymphoedema/chronic oedema and wounds in acute hospital in-patients in 5 different countries. Method: A point-prevalence study was carried out during working day periods in six general hospitals in four countries (Denmark, France, United Kingdom, Australia) and one hospital oncology in-patient unit in one other country (Ireland). The study used validated clinical tools for the assessment and collection of data. Data were collected by expert clinicians through interviews and physical examination of the patients present in the wards. Results: A total of 1905 patients could be included and investigated among the 3041 total bed occupancy in the seven hospitals. Lymphoedema/chronic oedema was present in 723 of them (38%). Main risk factors associated with chronic oedema were age, morbid obesity and heart failure as well as chair bound immobility and neurological deficiency. History of cellulitis was frequent in patients with chronic oedema and wounds (24.8%), chronic oedema alone (14.1%) as compared to the 1.5% prevalence in patients without chronic oedema. Conclusion: Lymphoedema/chronic oedema is very frequent in patients hospitalized in hospital acute wards. It is strongly associated with obesity, venous insufficiency and heart failure. Our results strongly suggest a hidden health care burden and cost linked to chronic oedema independently of chronic wounds

Wound Healing Project: Using wound care as a case study to assess the impact of public policy on healthcare.

Background: Chronic wound care represents a considerable burden to patients and the healthcare system, however often goes unrecognised. Through public policy the government directly impacts public health and the health of individuals with the aim of protecting people from potential health risk factors. Healthcare need assessments are of great importance to public policy makers since they provide a status quo of the health needs of a patient population, at a national or local level. Some authors argue that healthcare needs assessments should be legal requirements of public policy. Aim: To explore the influence of public policy on healthcare using wound care as a case study and to research wound care needs of a local population in Nottinghamshire. Methods: The study adopted a mixed method study design using a concurrent triangulation approach. Conceptually, the study utilised the Healthcare Needs Assessment framework. The qualitative study consisted of qualitative interviews with wound care commissioners, providers and healthcare professionals. The quantitative study involved a point prevalence study of wounds on a community nursing caseload in two Clinical Commissioning Group areas in Nottinghamshire. Data were analysed using constant comparative method and descriptive statistics. Findings: In total, 1,462 patients were assessed as part of the point prevalence study. The quantitative study shows that prevalence of wounds as well as associated conditions is increasing. Thirteen qualitative interviews explored how public policy impacts on community services. The qualitative study demonstrates that community nursing and tissue viability services are facing a lot of challenges caused by changing demographics and the New Public Management reform. Conclusion: Current public policies mean that healthcare providers are required to provide ‘more for less’ while increasing the quality of care. The influence of New Public Management reforms significantly affects community and tissue viability nurses causing a decreased satisfaction and increased workload

Telomere maintenance in liquid crystalline chromosomes of dinoflagellates

The organisation of dinoflagellate chromosomes is exceptional among eukaryotes. Their genomes are the largest in the Eukarya domain, chromosomes lack histones and may exist in liquid crystalline state. Therefore, the study of the structural and functional properties of dinoflagellate chromosomes is of high interest. In this work, we have analysed the telomeres and telomerase in two Dinoflagellata species, Karenia papilionacea and Crypthecodinium cohnii. Active telomerase, synthesising exclusively Arabidopsis-type telomere sequences, was detected in cell extracts. The terminal position of TTTAGGG repeats was determined by in situ hybridisation and BAL31 digestion methods and provides evidence for the linear characteristic of dinoflagellate chromosomes. The length of telomeric tracts, 25-80 kb, is the largest among unicellular eukaryotic organisms to date. Both the presence of long arrays of perfect telomeric repeats at the ends of dinoflagellate chromosomes and the existence of active telomerase as the primary tool for their high-fidelity maintenance demonstrate the general importance of these structures throughout eukaryotes. We conclude that whilst chromosomes of dinoflagellates are unique in many aspects of their structure and composition, their telomere maintenance follows the most common scenario

Microbial Contamination of Photographic and Cinematographic Materials in Archival Funds in the Czech Republic

In this study we investigated the microbial contamination of 126 samples of photographic and cinematographic materials from 10 archival funds in the Czech Republic. Microorganisms were isolated from the light-sensitive layer by swabbing it with a polyurethane sponge. Microbial isolates were identified by MALDI-TOF MS (bacteria) or by phenotype testing and microscopy (fungi). Bacterial contamination was more abundant and more diverse than fungal contamination, and both were significantly associated with archives. The most frequently isolated fungal genera were Cladosporium, Eurotium, Penicillium, Aspergillus and Alternaria. The most frequently isolated bacteria were Gram-positive genera such as Staphylococcus, Micrococcus, Kocuria, Streptococcus and Bacillus. This bacterial and fungal diversity suggests that air is the main vehicle of contamination. We also analysed the impact of the type of material used for the carrier (paper, baryta paper, cellulose acetate and nitrate or glass) or the light-sensitive layer (albumen, gelatine, collodion and other) on the level and diversity of microbial contamination. Carriers such as polyester and cellulose nitrate may have a negative impact on bacterial contamination, while paper and baryta paper may have a partially positive impact on both fungal and bacterial contamination