Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention : a qualitative study

AIMS AND OBJECTIVES: To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. BACKGROUND: Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as 'healing by secondary intention'. These wounds are often slow to heal, prone to infection, and complex to manage. DESIGN: A qualitative, descriptive approach, using semi-structured interviews. METHODS: Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of 'Framework' approach. Consolidated criteria for reporting qualitative research guided the study report. RESULTS: Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. CONCLUSIONS: Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. RELEVANCE FOR CLINICAL PRACTICE: Clinical decision making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments

Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review

Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience

On the mathematical model simplification using constant Lewis number – Impact assessment on heterogeneous char conversion process

Reactive systems in a thermochemical conversion domain are modelled considering N-specie, 1-energy and 2-mass conservation equations assuming negligible pressure gradient resulting in N+3 non-linear coupled PDE system with dependency on thermodynamic and transport properties. Typically, simplistic temperature-dependent polynomials are chosen for estimating thermal conductivity and specific heat, however, the estimation of mass diffusion coefficient (Di;mix) follows a complicated procedure involving kinetic theory culminating in Chapman-Enskog equation. This renders the solution computationally intensive. The complexity is simplified by assuming a constant Lewis (Le) number, a standard practice in the analytical solution for conventional reactive systems. In fixing Le, (Di;mix) is equated to thermal diffusivity (a ratio of thermodynamic properties) resulting in the specie and energy equation yielding a similar solution and collapse of N+3 system of simultaneous equations to 3 equations. The current article explores the validity and limitation of assuming constant Le in the simulation of char conversion process in air and steam. Results of char conversion are compared for fixed Le and D estimated with Chapman{Enskog expresion. The analysis suggests that Le remains invariant only under a severely restricted set of conditions. Fixing Le influences, the conversion process either over-/under-predicting the conversion time scales and the product gas composition

Tungsten, barium and base metal mineralization in a layer of amphibolite in Mesoarchaean Ghattihosahalli belt, western Dharwar craton, Karnataka, India

Scheelite together with barytes and base metals is found in a layer of para-amphibolite within the Mesoarchaean Ghattihosahalli schist belt in western Dharwar craton. Scheelite occurs as disseminated grains within the amphibolite layer which occurs at the interface between >3.34 Ga old sequence of ultramafic komatiite-komatiitic basalt and an overlying sequence of interbedded fuchsite quartzite, barytes, cherty quartzite and kyanite-sillimanite-quartz-sericite schist. This lithological assemblage is intruded by and co-folded with sheets of gneisses and granites of >3.0 Ga age (Peninsular gneiss). The source material of the mineralized amphibolite is probably derived from weathering of the underlying komatiitic basalt. The mineralization comprising of scheelite, barytes and basemetals in the amphibolite may have been formed by sea floor hydrothermal activity. The mineralized amphibolite is comparable in its geological setting and mineralization features to ∼3.8 Ga old Isua supracrustal belt of West Greenland. This new finding could be viewed as one of the oldest instances of Proto SEDEX-style base metal mineralization associated with barite deposits in the Indian shield

Temporal artery biopsy: time matters!

Temporal artery biopsy is the gold standard for Giant Cell Arteritis. However, timing of biopsy in crucial. Delay leads to false negative results