Baharestani M, Amjad I, Bookout K, Fleck T, Gabriel A, Kaufman D, McCord SS, Moores DC, Olutoye OO, Salazar JD, Song DH, Teich S, Gupta S. V.A.C. ® Therapy in the management of paediatric wounds: clinical review and experience. ABSTRACT Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure® (V.A.C.® Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.® Therapy System.

Bakgrund: Sårbehandling är en del av distriktssköterskans dagliga arbetsuppgifter, en uppgift som ofta är tidskrävande. Fokus läggs ofta på att hitta rätt förband och omläggningsintervall. Patientens levnadsvanor påverkar sårläkningsprocessen. Genom en helhetssyn och ett samarbete med patienten kan sårläkningen underlättas. Syfte: Syfte med studien var att beskriva hur distriktssköterskan arbetar med den äldre patientens levnadsvanor i samband med svårläkta bensår. Metod: Kvalitativ metod med induktiv ansats användes i studien.  Datainsamlingen genomfördes med en webbaserad, asynkron enkät. Urvalet bestod av distriktssköterskor från sydöstra regionen och det insamlade materialet analyserades med hjälp av en innehållsanalys.  Resultat: Distriktssköterskorna beskrev en bristande struktur i arbetet med patientens levnadsvanor. Dokumentationen gjordes på olika sätt inom primärvården och den kommunala hemsjukvården. Detta ledde till en bristande informationsöverföring och uppföljning. Distriktssköterskan diskuterades patientens levnadsvanor med öppna frågor och motiverande samtal. Samtidigt betonade de vikten av patientens eget ansvar. Distriktssköterskorna upplevde att levnadsvanorna borde medvetandegöras och tas upp mer i det dagliga arbetet. För att göra det behövdes tid och kontinuitet. Distriktssköterskorna beskrev att reflektion sällan genomfördes på ett strukturerat sätt. Reflektion efterfrågades av distriktssköterskorna för kunskapsutbyte och för att medvetandegöra levnadsvanorna. Slutsats: Trots att distriktssköterskorna har stor kompetens att arbeta med levnadsvanor i samband med sårläkning får det för lite fokus i det dagliga arbetet. Distriktssköterskornas förebyggande arbete ses som ett kärnelement i professionen. Levnadsvanorna behöver få en större plats i sårvårdsarbetet inom primärvården och den kommunala hemsjukvården för att uppmärksamma sambandet med sårläkning. / Background: Wound treatment is a part of the district nurse daily tasks, a task that is time consuming. The focus is often in finding the right dressing and conversion interval. The patient's lifestyle affects the wound healing process. Through a holistic view and a collaboration with the patient, wound healing can be facilitated. Aim: The aim of the study was to describe how the district nurse works with the elderly patient's lifestyle in connection with difficult-to-heal leg ulcers. Method: Qualitative method with inductive approach was used in the study. The data collection was carried out with a web-based, asynchronous survey. The sample consisted of district nurses from the southeastern region and the collected material was analyzed using a content analysis. Results: The district nurses described a lack of structure in the work with the patient's lifestyle. The documentation was made in different ways in primary care and municipal home health care. This led to a lack of information transfer and follow-up. The district nurse discussed the patient's lifestyle with open questions and motivational conversations. At the same time, they emphasized the importance of the patient's own responsibility. The district nurses felt that more attention should be paid to the importance of living habits. To do that, time and continuity are needed. The district nurses described that reflection is seldom carried out in a structured way. Reflection was requested by the district nurses for the exchange of knowledge and for raising awareness of living habits. Conclusion: Despite the fact that the district nurses have great competence in working with living habits in connection with wound healing, there is too little focus in the daily work. The district nurses' preventive work is seen as a core element in the profession. Living habits need to be given a greater place in wound care work in primary care and municipal home health care to draw attention to the connection with wound healing.

<p>  </p> <p>Infections of dermal wounds is a growing burden for the healthcare industry, with a 2017 market exceeding $17.5 USD. As the number of patients with severe infections continues to increase year after year, there is an alarming downward trend in efficacy for traditional antibiotic treatments. In large part, this is due to the increasing development of antibiotic resistance within common bacteria strains. As microbes evolve to protect themselves from previously effective drugs, there is a growing need for new antimicrobial therapies. While alternatives exist in the market, they are largely impaired by non-selective toxicity which can cause further damage to the cells in the wound bed, as is the case with silver and other strong antiseptics, or the need for high energy, specialized equipment, as with cold atmospheric surface treatments. Gaseous ozone is a promising alternative therapy for treating these wound infections. Because ozone is a strong natural oxidant, it exhibits significant antimicrobial properties, and has also been shown to help stimulate natural wound healing in many cases. Herein is presented the design of a portable system for the topical delivery of gaseous ozone as an antimicrobial treatment for infected dermal wounds. This includes the design and characterization of the portable system and a custom ozone application dressing, the characterization of the safety and efficacy of the system using <em>in vitro</em> and <em>in vivo</em> models, and a disposable system for wound infection monitoring. The system utilizes a portable corona discharge generator to produce gaseous ozone from the ambient environment. The ozone gas is delivered through a dressing engineered to have a hydrophobic interface at the wound bed and disperse the ozone gas across the patch surface for more uniform application. The antimicrobial strength and biocompatibility of the system was optimized at varying ozone output levels. Additionally, an adjunct therapy of topical antibiotics was shown to significantly increase the strength of the treatment without leading to greater cytotoxicity. This synergistic effect between ozone and antibiotics was shown to circumvent natural bacterial resistances to antibiotics, which will have a major impact on the wound care industry. This adjunct treatment was then validated on a porcine animal model for safety and pilot results for efficacy testing. Finally, the pH sensor which can be incorporated with use of the ozone therapy enables objective monitoring of wound condition and is able to signal when appropriate infection therapy should begin. As it stands, this portable ozone wound treatment system shows great promise as an alternative therapy to improve the quality of live for millions of patients.</p>

Providing care to child with a chronic, rare diseases has been identified as a major life stressor with a myriad of negative physical and mental health consequences. These stresses have previously been found to create burden that may impair caregiving efforts and increase the risk of mortality for both the caregiver and affected child. Many rare diseases affect children. It is not known how caregiver burden and the source of stress varies by disease. Qualitative methods have been used to understand caregiver experience with the rare disease, epidermolysis bullosa (EB), but no such studies have occurred in the United States. In order to better understand the experience of caregiving for a child with EB in the United States, a qualitative, phenomenological study was conducted. Data were collected via semi-structured interview concerning one primary research question, what is the general experience of being an EB caregiver?, and five sub-questions: (1) What stresses are specific to EB caregiving?, (2) How do EB caregivers learn to care for their child with severe EB?, (3) How do EB caregivers experience medical interactions?, (4) How do EB caregivers experience the hospitalization of their child?, and (5) How do EB caregivers cope with their caregiving role? Data analysis, using interpretive phenomenological analysis, yielded several novel findings. These included: an unusually strong emotional connection between the caregiver and child with EB, experiences of depersonalization or derealization for the EB caregiver during wound care, the positive impact of tempering expectations and celebrating for victories for the affected child, the regularity of medical injury for EB children, the traits of physicians perceived to be helpful or harmful, the stresses associated with hospitalization of children with EB, and how public recognition through community events buffers stress for EB caregiver. Finally, a framework of risk factor, protective factors, and burdensome outcomes was constructed. Risk factors were condensed into three domains: time constraints, financial problems, and pain in the affected child. Control and community supper were among the identified protective factors for EB caregivers. These findings have implications for counseling interventions for use EB caregivers, especially in hospital settings.

Bakgrund: Omläggning av brännskador är förenat med stort lidande för patienten i form av smärta och ångest. Det finns forskning som belyser enskilda strategier för att lindra detta lidande men det saknas forskning som sammanställer strategierna.    Syfte: Uppsatsens syfte var att sammanställa och värdera olika strategier, som kan användas av specialistsjuksköterskan inom intensivvård, för att lindra smärta och ångest hos brännskadade patienter vid såromläggning.  Metod: Uppsatsen var en deskriptiv litteraturöversikt som inkluderade 20 kvantitativa artiklar. Artikelgranskningen utfördes med hjälp av mallar från SBU och GRADE. Katie Erikssons teori om lidande var uppsatsens teoretiska utgångspunkt.    Resultat: I resultatet framkom olika kategorier för lindring av smärta, ångest och smärtrelaterad ångest vid omläggning av brännskador. Dessa var komplementära och medicinska strategier. Komplementära strategier var den kategori som visade på störst potential att minska smärta, ångest och smärtrelaterad ångest.   Slutsats: Komplementära och vissa medicinska strategier lindrar signifikant lidande i kombination med opioider och uppnår största möjliga lindring när den upprepas flera dagar i följd. För att lindra lidande vid omläggning av brännskador behöver specialistsjuksköterskan inom intensivvård anpassa vården efter patientens behov och önskemål. / Background: Burn wound dressing is associated with great suffering for the patient in the form of pain and anxiety. There is research that investigates strategies to alleviate this suffering, however there is a lack of research compiles these strategies.   Purpose: The purpose of the essay was to compile and evaluate different strategies, which can be used by specialist nurses in intensive care to relieve pain and anxiety in burn patients during wound dressing.   Method: The essay was a descriptive literature review that included 20 quantitative articles. Article review was performed using templates from SBU and GRADE. Katie Eriksson’s theory of suffering was the essay’s theoretical outset.   Results: Different categories for the relief of pain, anxiety and pain-related anxiety during dressing change of burn wounds emerged. These were complementary and medicinal strategies. Complementary strategies was the category that showed the greatest potential to reduce pain, anxiety and pain-related anxiety.   Conclusion: Complementary and certain medical strategies significantly alleviate suffering in combination with opioids and achieve the greatest possible relief when repeated over several consecutive days. In order to alleviate suffering when performing dressing changes of burn wounds, the specialist nurse in intensive care needs to adapt the care to the patient's needs and wishes.

Bakgrund: Förekomsten av svårläkta sår förväntas stiga i takt med en åldrande befolkning och ökande bakomliggande sjukdomar. Detta medför stora kostnader för vårdgivarna och behandlingstiderna riskerar att bli långa. Det innebär även mycket lidande och nedsatt livskvalitet för patienten. Svårläkta sår är en stor del av distriktssköterskans arbete, både inom primärvård och hemsjukvård. Motiv: Trots distriktssköterskors stora ansvar inom detta område är forskningsdata kring deras upplevelser samt hur de arbetar för att utveckla sin kunskap bristfällig. Syfte: Syftet med studien är att beskriva distriktssköterskors upplevelser av att behandla svårläkta sår samt undersöka hur de utvecklar sin kunskap.  Metod: Data har inhämtats genom semistrukturerade intervjuer med distriktssköterskor (N=10) inom primärvård och hemsjukvård, från mellersta och norra Sverige. En kvalitativ innehållsanalys med induktiv ansats har använts.  Resultat: Analysen resulterade i fyra kategorier; “Ett känslomässigt arbete”, “Möta människan bakom såret”, “Ett behov av organisation och samverkan” samt “Strävan efter kunskap och utbildning”.  Konklusion: Sårbehandling beskrevs som ett känslomässigt arbete där samarbete och struktur var viktigt. Distriktssköterskorna upplevde bristande organisation, kunskapsluckor samt avsaknad av fortbildningsmöjligheter. Det krävs mer forskning kring distriktssköterskors upplevelse av specialistutbildningen i förhållande till de kunskapskrav som ställs på arbetsplatsen. Resultatet ger även en fingervisning om politiska och organisatoriska förändringar som kan behövas och kan förhoppningsvis leda till en förbättring av arbetet med svårläkta sår. Detta skulle innebära minskat lidande och ökad livskvalitet för patienten. / Background: The prevalence of chronic ulcers is expected to increase in line with an aging population and increasing underlying diseases. This is associated with great costs to care providers and a risk for long treatment times. Chronic ulcers also cause suffering and reduced quality of life for the patient. Within a primary care or home care setting, a major part of a district nurse's assignment involves treating chronic ulcers. Motive: Despite district nurses profound responsibility regarding this subject there is a lack of research touching on the experiences of district nurses and how they develop their knowledge.  Aim: The aim of this study is to describe the experiences of district nurses caring for chronic ulcers including how they develop their knowledge. Methods: Data was collected through semi-structured interviews with district nurses (N=10) working in a primary care or home care setting, in the middle and north of Sweden. The data was analyzed via qualitative content analysis with an inductive approach. Result: The analysis resulted in four categories; “An emotional task”, “Meeting the human behind the ulcer”, “The need for organization and cooperation” and “The pursuit of knowledge and education”. Conclusion: Wound care is an emotional task where teamwork and structure was important. The district nurses experienced a lack in organization, knowledge and education opportunities. Further research is needed in how district nurses experience their education in relation to work related knowledge demands. The result also hints toward political and organizational alterations that could be needed. Hopefully it will lead to an improved way of working with chronic ulcers and in that way also less suffering and a better quality of life for the patient.

Bakgrund Honung har använts inom sårvård i tusentals år. Dock har den fallit i glömska i modern tid då sjukvården fick tillgång till antibiotika. Överutskrivning av antibiotika bidrar till att antibiotikaresistenta bakterier utvecklas. Nyare forskning visar att sårbehandling med honung uppfattas som lovande. Sjuksköterskor ansvarar för val av lämpliga förband vilket gör att sjuksköterskor behöver kontinuerlig utbildning för att kunna utföra en evidensbaserad praktik. Syfte Syftet med denna litteraturöversikt är att sammanställa forskningsbaserad kunskap om effekterna på sårläkning av medicinsk honung hos patienter med sår. Metod Litteraturöversikt bygd på tio vetenskapliga studier har genomförts som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Resultat Ett tema: God sårläkningsförmåga samt fyra huvudkategorier av effekter av medicinsk honung i sårläkningsprocessen: antimikrobiell effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet samt säkerhet har identifierats i denna studie. Slutsats Medicinsk honung har god sårläkningsförmåga tack vare sin antimikrobiella effekt, understöd till sårläkningsprocessen, förbättrad livskvalitet för patienterna samt säker användning. Medicinsk honung kan användas på alla typer av sår i olika faser av sårläkningsprocessen. Medicinsk honung är säker att använda både för vuxna och barn. Sjuksköterskornas evidensbaserade praktik ger en möjlighet att bidra till minskningen av användandet av antibiotika genom att välja medicinsk honung i sårbehandlingen. / Background Honey has been used in wound care for thousands of years. However, in modern times it has been forgotten ever since antibiotics was introduced. Overprescription of antibiotics can lead to antibiotic resistant bacteria. New research shows promising results with medical honey in wound care. Registered nurses are responsible to choose an appropriate wound dressing, this stipulates the need for a nurse to continuously update their knowledge in wound care to be able to perform evidence-based practice. Aim The aim with this literature review is to compile research-based knowledge about the effect on wound healing medical honey can provide on patents with wound. Method This literature review based on ten studies has been conducted as a structured literature review with elements of a systematic review. Results One theme: good wound healing ability and four head categories of effects of medical honey in wound healing process: antimicrobial effect, support of wound healing process, improved quality of life and security has been identified in this study. Conclusions Medical honey has good wound healing ability because of its antimicrobial effect, support of wound healing process, improved quality of life and safe for patients to use. Medical honey can be used on all types of wounds in different phases of the wound healing process. Medical honey is safe to use both for adults and for children. Nurses evidenced based practice give an opportunity to contribute to reduce the utilization of antibiotics by choosing medical grade honey in wound care.

Background: The economic, social and clinical negative effects of hard- to- heal wounds continue to increase. Antimicrobial resistance is also increasing and is today a public health problem in the world. Wound infection should primarily be treated with local treatment based on a structured approach. Aim: The purpose of the study was to describe the district nurse's experiences and knowledge of wound treatment for preventive measures and treatment to counteract and eliminate wound infection. Method: A qualitative interview study with an inductive approach and strategic selection. Twelve district nurses from different parts of Sweden participated. Results: By using antimicrobial dressings, antibiotics could be avoided in many cases for treatment of local wound infection. The wound treatment was based on a holistic approach with continuity and a pursuit of cross-professional collaboration. It was expressed that continuous training in wound treatment is required for optimal wound treatment to be carried out. Conclusion: The district nurse has the ultimate responsibility for wound treatment and has extensive knowledge of how to use preventive care against wound infection. This led to a reduction in the use of antibiotics, which is an important step in preventing further development of antimicrobial resistance. However, continued education and research in this area is required. / Bakgrund: De ekonomiska, sociala samt kliniska negativa effekterna av ett svårläkt sår fortsätter att öka och så även antimikrobiell resistens, som idag klassas som ett folkhälsoproblem i världen. Sårinfektion bör i första hand behandlas med lokal behandling utifrån ett strukturerat förhållningssätt. Syfte: Studiens syfte var att beskriva distriktssköterskans erfarenheter och kunskaper kring sårbehandling och preventiva åtgärder för att motverka och häva sårinfektion. Metod: En kvalitativ intervjustudie med induktiv ansats och strategiskt urval. Tolv distriktssköterskor från olika delar av Sverige deltog.  Resultat: Genom användning av antimikrobiella förband kunde antibiotika i många fall undvikas som behandling vid lokal sårinfektion. Sårbehandlingen utgick från ett holistiskt synsätt med kontinuitet och en strävan efter ett tvärprofessionellt samarbete. Det uttrycktes att det krävs fortlöpande utbildning inom området för att optimal sårbehandling ska kunna bedrivas. Konklusion: Distriktssköterskan har det yttersta ansvaret för sårbehandling och har stor kunskap kring hur preventivt arbete mot sårinfektion kunde genomföras. Det medförde att användning av antibiotika minskade vilket är ett viktigt steg i att förhindra fortsatt utveckling av antimikrobiell resistens. Det krävs dock fortsatt utbildning och forskning inom det här området.

Introduction: Pressure ulcers are one of the most monitored indicators of nursing care. Thanks to a well-functioning interdisciplinary team, pressure ulcers can be effectively prevented. Main aims of the thesis: The aim of this work is to map the role of nurse in an interdisciplinary team, to describe how the interdisciplinary teams currently work and what the effectiveness of their work is in relation to the prevention of pressure ulcers and their healing. Methodology: A qualitative research survey was used to collect the data in the form of semi-structured interviews wtih nurses. The selection criterion was the fact that they encounter patients suffering from pressure sores. The informants were getting method Snow ball. The resulting set of informants consisted of 15 persons. The results of the interviews were processed using the open-coding technique of pencil and paper and then divided into six categories. Results of the thesis: Research shows that the nurse plays a key role in the interdisciplinary team in the care of a patient with pressure ulcers. Her role is to work with other team members, direct patient care, preventive work and family contact. The results show that the nurse is a full member of the team. The overall care effect of the interdisciplinary team is ineffective in some departments, because, as it happens that individual workers do not work together. In our research, we mainly come across the absence of a nutritional therapist. Also, nurses would welcome more cooperation from lower medical staff. Furthermore, nurses perceive the use of scales as a certain obligation, and in some cases report their incorrect evaluation. Last but not least, we are confronted with ignorance and non-compliance with the standards of pressure ulcers treatment. Conclusion: We would like to convey the results achieved by the necessity of cooperation of all workers who care for a patient with pressure ulcers. The provision of complex care is essential in this area, because pressure ulcers are multifactorial. The use of interdisciplinary teams in the care of a patient with pressure ulcers brings the possibility to use people with different expertise, knowledge and experience. Together, they effectively work towards the early recovery of the patient, shortening the hospitalization period and saving the cost of hospitalization.

Aggressive hospital discharge policies adopted in the 1990s led to an influx of patients recovering from acute illness accessing post-acute home care services. Performance of the post-acute home care program in the Saskatoon Health Region was examined using formative program evaluation methods. Brief surveys of clients and nurse providers captured: care objectives and service outcomes; patient-centeredness; trust in providers; health improvement/decline; emotional/social functioning; functional status; injury avoidance; and overall quality. For clients, perceptions of quality were significantly affected by patient centeredness and experiencing unexpected health complications, which accounted for 83.0% of the variation. For nurse providers, overall quality of care was significantly related to patient centeredness, service outcomes, team communication and injury avoidance. Analysis revealed for clients with complex needs, the service period could be extended from 60 to 97 days which would cover 50.0% of clients. The research examining administrative data predicted the dependent variable Log of Total Care Hours (TCH) to enable analysis using General Linear Modelling. The results showed post-acute home care clients referred from Emergency Departments received approximately 84.2 % more TCH; post-acute home care clients referred from Surgical wards received approximately 42.1% more TCH; and post-acute home care clients referred from Cardiology received approximately 66.3% more TCH than clients referred from the community. Furthermore, single clients received more TCH than married clients. Nursing chart reviews of post-acute home care clients with wound care also predicted the Log of TCH to enable analysis using General Linear Modelling. Post-admission, 11.3% of post-acute home care clients receiving wound care displayed clinical signs and symptoms of emerging infection, while 19.7% displayed clinical signs and symptoms of acquired infection. Post-acute home care clients receiving wound care experiencing injury, trauma or harm while admitted to home care received approximately 53.3% TCH; and post-acute home care clients who acquired an infection after admission received approximately 70.2% TCH. The implications of this research suggest there is room to improve post-acute home care services to address client re-hospitalisation, unexpected health symptoms/complications, and wound care.