Specialist tissue viability services: a priority or a luxury?

During the 1980s, the number of tissue viability nurses (TVNs) rose steadily in the UK, in response to mismanagement of patients with wounds (Fletcher, 1995). Since this time, and in response to the quality agenda, the necessity of promoting a tissue viability service (TVS) that is able to meet the needs of a changing population, while being cost effective and offering interventions based on research and evidence, has grown. The drive to reduce avoidable harm in healthcare and to make efficiency savings is continuing, with TVS being one of the key areas to deliver these targets. However, across the UK we have a wide range of role descriptions and job titles, yet little clarification as to the qualifications and skills required to deliver a successful TVS. Infection control specialist nurses have a clear identity with concise role descriptions representing a range of pay bands. Arguably, this is because they are aligned with a medical specialty, whereas TV is not. The introduction of ‘Any Qualified Provider’ (Department of Health, 2011) has witnessed some services, including management of leg ulceration, being delivered by non-NHS providers at a reduced cost. So is TVS in danger of becoming more of a ‘nice thing’ rather than a priority

Can the design of glove dispensing boxes influence glove contamination?

Background Few studies have explored the microbial contamination of glove boxes in clinical settings. The objective of this observational study was to investigate whether a new glove packaging system in which gloves are dispensed one by one vertically with the cuff-end first has lower levels of contamination on the gloves and on the surface around the box aperture compared to conventional horizontally dispensed glove boxes. Methods Seven participating sites were provided with vertical glove dispensing systems and conventional boxes. Before opening boxes, the surface around the aperture was sampled microbiologically to establish base-line levels of superficial contamination. Once the boxes were opened, the first pair of gloves in each box were sampled for viable bacteria. Thereafter, testing sites were visited on a weekly basis over a period of six weeks and the same microbiological assessments made. Results The surface surrounding the aperture of the modified dispenser boxes became significantly less contaminated than the conventional boxes (P < 0.001) with an average of 46.7% less contamination around the aperture. Overall, gloves from modified boxes showed significantly less colony-forming units contamination than gloves from conventional boxes (P < 0.001). Comparing all sites over the entire six-week period, modified dispensed gloves had 88.9% less bacterial contamination. Conclusion This simple improvement to glove box design reduces contamination of unused gloves. Such modifications could decrease the risk of microbial cross-transmission in settings that utilise gloves. However, such advantages do not substitute for strict hand-hygiene compliance and appropriate use of non-sterile, single-use gloves

Wound infection in clinical practice : principles of best practice

The International Wound Infection Institute (IWII) is an organisation of volunteer interdisciplinary health professionals dedicated to advancing and improving practice relating to prevention and control of wound infection. This includes acute wounds (surgical, traumatic and burns) and chronic wounds of all types, although principally chronic wounds of venous, arterial, diabetic and pressure aetiologies. Wound infection is a common complication of wounds. It leads to delays in wound healing and increases the risk of loss of limb and life. Implementation of effective strategies to prevent, diagnose and manage, is important in reducing mortality and morbidity rates associated with wound infection. This second edition of Wound Infection in Clinical Practice is an update of the first edition published in 2008 by the World Union of Wound Healing Societies (WUWHS). The original document was authored by leading experts in wound management and endorsed by the WUWHS. The intent of this edition is to provide a practical, updated resource that is easy-to-use and understand. For this edition, the IWII collaborative team has undertaken a comprehensive review of contemporary literature, including systematic reviews and meta-analyses when available. In addition, the team conducted a formal Delphi process to reach consensus on wound infection issues for which scientific research is minimal or lacking. This rigorous process provides an update on the science and expert opinion regarding prevention, diagnosis and control of wound infection. This edition outlines new definitions relevant to wound infection, presents new paradigms and advancements in the management and diagnosis of a wound infection, and highlights controversial areas of discussion

Developmental changes in word recognition threshold from two to five years of age in children with different middle ear status

The aims were to: (1) provide word recognition thresholds (WRTs) at 31, 43, and 61 months of age; (2) investigate developmental changes over time; (3) investigate the relationship between OME and WRT, and (4) investigate the relationship between WRT and hearing thresholds. Around 1000 children were tested longitudinally as part of the ALSPAC study, using an adaptive measure of word recognition in quiet. Mean WRTs were 28, 23, and 23 dB (A) at 31, 43, and 61 months, respectively. Normal auditory development is associated with a mean improvement in WRT of 5 dB between age 31 and 61 months. There was a mean increase in WRT of 5 dB and 15 dB when OME was present in one and two ears, respectively. Thus, both unilateral and bilateral OME results in a detrimental effect on hearing ability for speech. Additionally, early and ‘persistent’ OME is associated with greater disability. However by 61 months, previous OME status was not significant. To our knowledge, this is the largest longitudinal study reporting WRT in preschool children with different middle ear status

The surgical wound in infrared: thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section

Background Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman’s community physician with logistic regression models derived to model dichotomous outcomes. Results Fifty-three women aged 21–44 years with BMI 30.1–43.9 Kg.m− 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for ‘professional’ opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%; Conclusions IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing

CRISPR-Cas9 screens in human cells and primary neurons identify modifiers of C9ORF72 dipeptide-repeat-protein toxicity.

Hexanucleotide-repeat expansions in the C9ORF72 gene are the most common cause of amyotrophic lateral sclerosis and frontotemporal dementia (c9ALS/FTD). The nucleotide-repeat expansions are translated into dipeptide-repeat (DPR) proteins, which are aggregation prone and may contribute to neurodegeneration. We used the CRISPR-Cas9 system to perform genome-wide gene-knockout screens for suppressors and enhancers of C9ORF72 DPR toxicity in human cells. We validated hits by performing secondary CRISPR-Cas9 screens in primary mouse neurons. We uncovered potent modifiers of DPR toxicity whose gene products function in nucleocytoplasmic transport, the endoplasmic reticulum (ER), proteasome, RNA-processing pathways, and chromatin modification. One modifier, TMX2, modulated the ER-stress signature elicited by C9ORF72 DPRs in neurons and improved survival of human induced motor neurons from patients with C9ORF72 ALS. Together, our results demonstrate the promise of CRISPR-Cas9 screens in defining mechanisms of neurodegenerative diseases

Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries

Background: Skin tears are acute wounds that are frequently misdiagnosed and under‐reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. Objectives:To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. Methods: A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two‐round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter‐rater reliability and intrarater reliability of the instrument. Results:A definition for the concept of a ‘skin flap’ in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79–0·80] and sensitivity ranged from 0·74 (95% CI 0·73–0·75) to 0·88 (95% CI 0·87–0·88). The inter‐rater reliability was 0·57 (95% CI 0·57–0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73–0·75). Conclusions: The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally.info:eu-repo/semantics/publishedVersio

Compassionate wound care: An integrated intervention for people who self-injure

This article discusses how an integrated physical, psychological and social approach to wound care can help improve the quality of life for people who self-injure. The health professional should demonstrate compassion while teaching the person who self-injures how to provide their own wound care. Compassionate care may help the patient improve their self-compassion and reduce shame associated with this coping strategy, which may in turn avoid exacerbating self-harm when seeking healthcare

Transabdominal ultrasonographic evaluation of fetal well-being in the late-term mare and cow

In the equine practice, attempts have been made to examine the fetus in the second and third trimester of pregnancy but all of the available methods have limitations. Until now, transabdominal ultrasonography has been regarded as the most informative examination. This method allows us to measure fetal heart rate, fetal activity as well as the quality and quantity of the fetal fluids. A modified biophysical profile for horses was used by several researchers in the USA from the 1990s as a gold standard. However, it is not sensitive enough and, in the authors’ experience, professionals can face difficulties during its application (e.g. for measuring aortic diameter and fetal breathing movements). In cows, this method was first used for this purpose by a Canadian research group in 2007. They reported that transabdominal ultrasound was promising but showed low sensitivity in this species. The present studies show that birth weight cannot be predicted from fetal aortic diameter measurement in cows as suggested by other researchers. Transabdominal ultrasound needs special equipment (2–3.5 MHz convex transducer) and basic ultrasonographic knowledge; however, we suggest that in most cases it can be performed with the dam placed in a stock and without shaving the examination area. The method provides useful information within 30–40 minutes, enabling the examiner to determine whether or not the fetus is alive and to recognise placentitis or twins. This technique also allows measuring the combined thickness of the uteroplacental unit, and the authors’ ongoing study showed higher normal values in Lipizzaner mares compared to values in other breeds. In conclusion, with the help of advanced techniques, simple and low-cost methods should be developed for the evaluation of the pregnant dam and its fetus to assess fetal viability in the veterinary practice

The Great American Crime Decline : Possible Explanations

This chapter examines the most important features of the crime decline in the United States during the 1990s-2010s but also takes a broader look at the violence declines of the last three centuries. The author argues that violent and property crime trends might have diverged in the 1990s, with property crimes increasingly happening in the online sphere and thus traditional property crime statistics not being reflective of the full picture. An important distinction is made between ‘contact crimes’ and crimes that do not require a victim and offender to be present in the same physical space. Contrary to the uncertainties engendered by property crime, the declines in violent (‘contact’) crime are rather general, and have been happening not only across all demographic and geographic categories within the United States but also throughout the developed world. An analysis of research literature on crime trends has identified twenty-four different explanations for the crime drop. Each one of them is briefly outlined and examined in terms of conceptual clarity and empirical support. Nine crime decline explanations are highlighted as the most promising ones. The majority of these promising explanations, being relative newcomers in the crime trends literature, have not been subjected to sufficient empirical scrutiny yet, and thus require further research. One potentially fruitful avenue for future studies is to examine the association of the most promising crime decline explanations with improvements in self-control