Special Issue "Wound Care"


A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 June 2014)

Special Issue Editor

Guest Editor
Dr. Zena Moore
Acting Head of School, School of Nursing, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
Website: http://www.rcsi.ie/index.jsp?a=885&n=226&p=142
E-Mail: zmoore@rcsi.ie
Interests: wound healing and tissue repair; pressure ulcer prevention and management; quantitative research methods; design, conduct and analysis of clinical trials; epidemiology; clinical nurse specialists; evidence based practice; research implementation; systematic reviews; quality of life; health economics

Special Issue Information

Dear Colleagues,

Wounds and the many associated problems have challenged health care providers for centuries and today, despite the wealth of knowledge available, neither the incidence nor prevalence of wounds is reducing. Furthermore, in view of our changing demographic profile and the projected increase in the older population, it is likely that wound management will become an ever increasing burden to the individual, health care services and society as a whole. The annual incidence of wounds in the EU-27 is approximately 4 million, and between 25% and 50% of acute hospital beds are occupied by patients with a wound, with up to 60% of these representing non-healing wounds (infected surgical wounds, pressure ulcers, leg/foot ulcers) The increasing prevalence and incidence of non-wounds healing is closely linked with quality of care and, as such, these rising figures reduce society’s confidence in the health service’s ability to deliver care that is timely, appropriate and effective. Thus, for those involved in this specialist area of clinical practice, the fundamental goal is to improve clinical outcomes, reduce the burden of wounds and improve health related quality of life.

Dr. Zena Moore
Guest Editor


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  • wound care
  • pressure ulcer
  • diabetic foot ulcer
  • leg ulcer
  • non-healing wound
  • health related quality of life
  • cost effectiveness

Published Papers (4 papers)

by ,  and
Healthcare 2014, 2(3), 315-323; doi:10.3390/healthcare2030315
Received: 18 June 2014; in revised form: 2 August 2014 / Accepted: 15 August 2014 / Published: 27 August 2014
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by , , , ,  and
Healthcare 2014, 2(3), 299-314; doi:10.3390/healthcare2030299
Received: 18 March 2014; in revised form: 3 July 2014 / Accepted: 10 July 2014 / Published: 25 July 2014
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Healthcare 2014, 2(3), 272-281; doi:10.3390/healthcare2030272
Received: 31 March 2014; in revised form: 10 June 2014 / Accepted: 2 July 2014 / Published: 21 July 2014
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by , , , , , ,  and
Healthcare 2014, 2(2), 183-191; doi:10.3390/healthcare2020183
Received: 13 January 2014; in revised form: 3 March 2014 / Accepted: 21 March 2014 / Published: 8 April 2014
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Article
Functional and Social Dimensions of An Innovation’s Characteristics for Pressure Ulcer Prevention in Long-Term Care Facilities
Tracey L. Yap, RN, PhD1,2, Susan Kennerly, RN, PhD3, Kirsten Corazzini, PhD, FGSA1, Kristie Porter, MPH4, Mark Toles, RN, PhD5,2, Ruth Anderson, RN, PhD, FAAN1
1 Duke University School of Nursing; 2 NHCGNE Claire M. Fagin Fellow; 3 University of North Carolina Charlotte; 4 RTI International; 5 University of North Carolina Chapel Hill
Pressure ulcer (PU) prevention is a challenge in nursing homes. Numerous factors increase risk for PUs, and evidence is unclear about which, if any, prevention approach is more effective, but everyone can reduce risk by increasing mobility. We evaluated perceptions of staff involved in a 12-month paired-facility randomized nurse-led innovation conducted in 10 Midwestern facilities; full-length musical cues were used to prompt multidisciplinary teams to move/reposition all residents (not just those at risk for PUs) every 2 hours during the daytime. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Methods: Focus groups (n=8) were conducted with staff (n=45) to explore perceptions of adoptability, effectiveness, and the innovation’s intrinsic characteristics. The Diffusion of Innovations model’s a-priori codes (Compatibility, Complexity, Observability, Relative Advantage, Sustainability, Trialability), were used for qualitative content analysis. Transcribed verbatim focus group sessions’ data were coded by 5 analysts. Code definitions were developed and refined until achieving 85% agreement for inter-rater reliability. Results: Innovation characteristics emerged in either the functional (Complexity, Relative Advantage) or social (Compatibility, Observability, Sustainability, Trialability) dimension. Main themes identified in the functional dimension were less positive since additional documentation of resident movement was required and the timing of cues was not always ideal. The innovation’s social dimension was considered strong and compatible, e.g., music cueing was helpful and improved quality of life for both residents and staff. Conclusions: Cueing multidisciplinary teams to encourage movement/repositioning of all residents holds promise for reducing facility-acquired PUs. These findings extend beyond PU prevention innovations and suggest that cueing may lead to other positive functional and social behavior changes for residents and staff. The social implications of music merit further investigation.

Title: Exploring resilience when living with a wound – an integrative literature review
K. Ousey1, KL Edward2
1 Centre for Health and Social Care, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, United Kingdom, HD1 3DH
2 Nursing Research Unit STV Private Hospital ( Melbourne) Associate Professor Nursing Research Australian Catholic University, Melbourne
: The psychological impact for patients with wounds can be significant, and adverse psychological effects occur most often when there are permanent changes in the body's structure or function. The emotional, social and psychological impact of wounds has been the focus of some studies; however, the notion of resilient behaviours in the context of this phenomenon has received little attention. The aim of this integrative review is to illuminate the construct of resilience for these patients and how this may inform contemporary practice.

Type of Paper: Article
The Role of Preference on Outcomes of People Receiving Evidence-informed Community Wound Care in their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230
Authors: Margaret B. Harrison 1,*, Elizabeth VanDenKerkhof 1,2, Wilma M. Hopman 3,4 and Meg E. Carley 1
1School of Nursing, Queen’s University, Kingston, Ontario, Canada;
Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada;
Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada;
Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada; E-Mail: margaret.b.harrison@queensu.ca
In a unique opportunity we followed a cohort of community-dwelling individuals receiving wound- care in a large urban-rural region. Some had their choice of where they received care and others were randomly allocated. The opportunity presented during a trial evaluating outcomes of receiving care in a nurse-clinic or at home (both groups received care from specially-trained nurses using an evidence-informed protocol). After trial initiation, many approached were willing to participate if they had their preference of care location. We enrolled them as a 'choice' cohort following them in the same manner as the trial participants to examine whether having choice made a difference to outcomes. By combining these two cohorts for the current analysis, we investigated the role of preference and location of care on outcomes. From a planning perspective we describe characteristics for people with stated preference and those allocated to where care is delivered. Outcomes included satisfaction with care, quality of life and healing. From a health services perspective there is interest in offering wound-care in nurse clinics as well as home-visiting, thus the general question about outcomes of care in a clinic setting versus homecare was undertaken.
patient preference; community wound-care; leg ulcers; community clinics; homecare

Type of Paper: Article
Antifungal Effect of Non-Woven Textiles Containing Polyhexamethylene Biguanide with Sophorolipid for Tinea Pedis Prevention
Hiromi Sanada
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; E-Mail: hsanada-tky@umin.ac.jp
Tinea pedis is a preventable skin disease common in elderly or diabetic patients. Daily foot washing is effective for prevention, but can be difficult for many patients. Additionally, conventional methods cannot eliminate fungi within the stratum corneum, a common site for fungal invasion. This study investigates the antifungal effects, cytotoxicity, permeability, and efficacy of non-woven textiles containing polyhexamethylene biguanide (PHMB) mixed with sophorolipid. Permeability of PHMB with varying concentrations of sophorolipid was assessed via a cultured skin model. Stratum corneum PHMB concentration was quantified by polyvinylsulphuric acid potassium salt titration and cytotoxicity was assayed via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). Antifungal effects were evaluated via a new cultured skin / Trichophyton mentagrophytes model, with varying PHMB duration. Colony forming units (CFU) of fungi were counted. Clinically-isolated Trichophyton were applied to the feet of four healthy volunteers. Fungal CFUs were evaluated after washing with soap, a non-woven textile with PHMB, the textile without PHMB, or without washing. Sophorolipid facilitated PHMB permeation into the stratum corneum. PHMB antifungal effects were achieved at 1 hour, with low cytotoxicity. Textiles containing PHMB reduced CFU of fungi in healthy volunteers to levels comparable to soap washing. Our results indicate the utility of this product for tinea pedis prevention in clinical settings.

Type of Paper: Summary Analysis
Summary-Analysis of Transcutaneous Topical Oxygenation on Lower Extremity Wounds
Howard M Kimmel, DPM, MBA, Melanie Johnson, DPM, Jamie Matteo DPM, Chris Phillips DPM, Perry J. Williams
Case Western Reserve University School of Medicine; e-mail: buckeyefootcare@sbcglobal.net
Oxygen is an essential component of wound healing. The discovery of it’s critical role in maintaining life and healing properties dates back to the late 1700’s. With the invention of hyperbaric oxygen chamber in 1879 research into the medicinal utilization of oxygen began and continues today. More recently, hyperbaric oxygen therapy has been studied and implemented for a variety of functions including wound healing, but recently its effectiveness has been questioned. Due to some of it’s more adverse side effects, the development of a more localized therapy option transcutaneous topical oxygenation has found its niche in the role of wound healing. Compiling the research and studies of the use of transcutaneous topical oxygenation in the literature, a statistical analysis was utilized to evaluate its efficacy in wound healing.

Type of Paper: Article
Sustaining Behaviour Changes Following a Venous Leg Ulcer Client Education Program
Charne Miller 1, Suzanne Kapp 2
1 La Trobe University, Alfred Health Clinical School, Level 4, The Alfred Centre, 99 Commercial Road, Prahran, Victoria 3181, Australia; E-Mail: C.Miller@latrobe.edu.au;
RDNS Institute, 31 Alma Road, St Kilda, Victoria, 3182, Australia
Venous leg ulcers are a symptom of chronic insufficiency of the veins for which treatment and maintenance reflect many of the characteristics of other chronic conditions. Self-management programmes for people with a venous leg ulcer, though fewer and less well evaluated than other diseases, suggest they are effective and well accepted. Evaluation of long term maintenance of behaviour changes arising from these programs is largely absent from the literature. This study considered the sustainability of behaviour changes arising from a client focus e-learning education program called the ‘Leg Ulcer Prevention Program’ (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n=49) examination of behaviour maintenance over a pre/post evaluation study of the LUPP education and 6 month Randomised Controlled Trial (RCT) of two compression stocking products post healing (an average of 34 weeks). Comparisons of behaviour maintenance were considered between RCT participants (n=100) who received the LUPP education and those that did not. Behaviours assessed were level of activity, calf muscle exercises, leg elevation, use of a soap substitute and use of a moisturiser. While the percentage of participants conducting the five health behaviours assessed exceeded the baseline levels, maintenance amongst participants who received the LUPP education varied. Physical activity continued to increase over time, leg elevation, calf muscle exercises, and soap substitute use fluctuated over the time points, and use of a moisturiser showed gradual decline. Significant differences were found between the LUPP and non-LUPP groups in the RCT for conduct of calf muscle exercises which were sustained over the 13 week [χ2 (1)=5.792, p=0.016] and 26 week [χ2 (1)=7.062, p=0.008] follow up data collections and for the use of a soap substitute which was only significant at the 13 week follow up [χ2 (1)=7.211, p=0.007]. There was no difference in adherence to compression therapy and whether the participant had received the LUPP education [t(90.32)=0.094, p=.925]. The provision of a client focused venous leg ulcer program produced behaviours changes that had varied sustainability across the evaluation period.

Type of Paper: Article
Wounds and quality of life, the validation and use of the woundQoL assessment
Herberger, K.; Augustin, M.; Baade, K.; Blome, C.
Comprehensive Wound Center (CWC), Institute for Health Services Research in Dermatology and Nursing, University Clinics of Hamburg, Germany
Chronic wounds have a major socio-economic impact due to their frequency, chronicity and societal costs. Patients experience substantial quality of life impairments. The continuous assessment of quality of life and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline-based wound care. For measuring the quality of life in wound patients, three instruments are currently being used, the Würzburg Wundscore, the Cardiff Wound Impact Schedule, and the Freiburg Life Quality Assessment for wounds. Although these widely used questionnaires focus on various spheres of life and disease specific impairments, their extent may reduce willingness to use in daily practice. For this, our aim was to develop a short and easy to use questionnaire and a practical treatment recommendation based on the questionnaire. We developed the "Wound-QoL" in cooperation with the authors of the existing assessment tools consisting of 17 questions which cover the core content of the three questionnaires. Each question refers to a certain impairment caused by the wound disease within the last seven days. The Wound-QoL leads to a numeric value for every single patient. Both global score and subscale scores were internally consistent with Cronbach's alpha between 0.71 and 0.91 in a so-called virtual validation study. The global score showed significant validity regarding convergent criteria such as generic quality of life (r=0.48 to 0.69) and responsiveness (r=0.18 to 0.52). As a further innovation, we developed an additional documentation sheet proposing possible interventions based on the areas with the highest impairments. The Wound-QoL and the documentation sheet enable to use the patients’ statements on quality of life fast and simple in the daily routine. This can lead to an improved and more patient-centered treatment of wounds. A longitudinal validation study on the Wound-QoL is currently being conducted.

Type of Paper: Review
Title: Complex Abdominal Wall Reconstruction
Miss S Das Mohapatra DNB, FRCS; Locum Consultant Colorectal Surgeon, St George’s Hospital NHS Trust, London SW17 0QT; E-Mail: mittydm@yahoo.com; Alastair C Windsor MD, FRCS; Consultant Colorectal Surgeon, UCLH, London NW1 2B; E-Mail: alwindsor@aol.com
Abdominal wall defects arise as a result of one or more missing component layers of the abdominal wall. A multiplicity of surgical procedures are associated with complex, recurrent abdominal wall defects, which can occur as a result of failed endeavor at previous repair, trauma, infection, radiation, necrosis, or malignancy. In the acute setting post operative open abdominal wound also poses a significant challenge. There has been a balanced increase in availability of a variety of synthetic materials and biological meshes for the repair of such defects. The use of prosthetic materials is now being replaced by the biologic mesh due to the perceived reduction in infection, recurrence and mesh extrusion rates. This review discusses the pros and cons of the currently available reconstruction options for such complex defects in the abdominal wall.

Last update: 22 July 2014

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