Mark Hayter

A systematic review of silver-releasing dressings in the management of infected chronic wounds.

AIM This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds. BACKGROUND Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so. METHODS A systematic review of literature from 1950-May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds. RESULTS Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors. CONCLUSION The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies. RELEVANCE TO CLINICAL PRACTICE This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.

Symptom burden and quality of life in patients with malignant fungating wounds

AIM This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds. BACKGROUND Malignant fungating wounds are complex wounds that can bleed, become malodorous due to infection and are painful causing physical and psychological distress. However, there is a lack of literature on the impact that such wounds can have on quality of life. METHODS This was a descriptive, cross-sectional multi-centre study of patients with malignant fungating wounds. Participants were recruited from the palliative care, hospice, outpatient clinic and oncology units of three medical centres in Taiwan. Data were collected from February 2008 to August 2009. A structured questionnaire obtained socio-demographic information, medical details, wound assessment information and the Taiwanese version of the McGill quality of life questionnaire was administered by interview. RESULTS   McGill quality of life scores indicated that the participants had the lowest quality of life. The participants age, dressing change frequency, pain, wound dressing comfort, wound symptom, bleeding and malodour had statistically significant negative correlations with quality of life. Multiple regression analysis showed that age, malodour, pain issues and psychological issues explained 87% of the total variance in quality of life. CONCLUSION   This study contributes to our understanding of the impact of malignant fungating wounds and how correct assessment and management is necessary to improve quality of life. Educational intervention research is needed for patients and caregivers in countries where this has not yet been performed. Further research should also identify whether nursing competence has a direct impact on quality of life.

A critical review and synthesis of qualitative research on patient experiences of critical illness

AIMS To critically review the literature in order to describe the themes associated with the experience of critical illness and consider how these inform the patients understanding. BACKGROUND Critical illness requires life-saving intervention and application of high technology medicine and intensive nursing within a specialist critical care unit. Whilst an extensive and rapidly advancing knowledge of the physiological basis for treating critical illness exists, understanding how critical illness is experienced by the patient is less well understood. DATA SOURCES Literature was retrieved through systematic searching of electronic databases, hand searches of journals and incremental searching. REVIEW METHODS 26 qualitative studies of firsthand experiences of adult patients who had been in a critical care unit were reviewed. Key, common, explicit themes between the studies were identified as well as implicit themes that emerged through preliminary synthesis. RESULTS Eight common explicit themes were identified. These included: Transformations of perception: Unreal experiences and dreams; Proximity to death; Transformation and perception of the body in illness; Transformation and perception of time; The critical care environment: technology and dependence; Care, communication and relationships with healthcare professionals; The support of family and friends and desire for contact; Transfer from critical care and recovery from critical illness. A further two implicit themes related to the primacy of the critical care unit within the studies; and the focus of recall or personal meaning which divided the literature. CONCLUSION The explicit themes highlight the steps taken by researchers to understand what is salient about the critical care experience for those who have been critically ill. Future research exploring the whole illness-recovery trajectory and the way personal meaning contributes to understanding life experiences is justified.

Multimedia education programme for patients with a stoma: effectiveness evaluation.

AIM This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. BACKGROUND Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. METHOD A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n=46) or a conventional stoma education programme (n=56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. FINDINGS Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. CONCLUSION Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments.

‘Selling it as a holistic health provision and not just about condoms …’ Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in – or closely linked with – schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop ‘young people friendly’ services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision – and inter-professional collaboration – in a climate where, in many schools, there is still considerable ambivalence about discussing ‘sex’ openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools.

A cost–effectiveness analysis of a multimedia learning education program for stoma patients

STUDY AIMS The purpose of this study was to compare the costs and effectiveness of enterostomal education using a multimedia learning education program (MLEP) and a conventional education service program (CESP). BACKGROUND Multimedia health education programs not only provide patients with useful information in the absence of health professionals, but can also augment information provided in traditional clinical practice. However, the literature on the cost-effectiveness of different approaches to stoma education is limited. DESIGN This study used a randomised experimental design. METHODS A total of 54 stoma patients were randomly assigned to MLEP or CESP nursing care with a follow-up of one week. Effectiveness measures were knowledge of self-care (KSC), attitude of self-care (ASC) and behavior of self-care (BSC). The costs measures for each patient were: health care costs, MLEP cost and family costs. RESULTS Subjects in the MLEP group demonstrated significantly better outcomes in the effectiveness measures of KSC, ASC and BSC. Additionally, the total social costs for each MLEP patient and CESP patient were US

Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals: a qualitative study

7396·90 and US

Authors and readers beware the dark side of Open Access

8570·54, respectively. The cost-effectiveness ratios in these two groups showed that the MLEP model was better than the CESP model after one intervention cycle. In addition, the Incremental Cost Effectiveness Ratio was -20·99. CONCLUSION This research provides useful information for those who would like to improve the self-care capacity of stoma patients. Due to the better cost-effectiveness ratio of MLEP, hospital policy-makers may consider these results when choosing to allocate resources and develop care and educational interventions. RELEVANCE TO CLINICAL PRACTICE This study provides a cost effective way of addressing stoma care in the post-operative period that could be usefully transferred to stoma care settings internationally.

Sexual health information seeking: a survey of adolescent practices.

Aim: To explore health professionals’ experiences of barriers and facilitators to referring patients for pulmonary rehabilitation in a primary care setting. Background: Pulmonary rehabilitation involves a multidisciplinary teamwork approach to improving the quality of life for people with chronic obstructive pulmonary disease. This study aimed to find out about health care professionals’ experiences when referring patients. Reports suggest that a health care professional’s attitude towards a treatment affects the willingness of patients to accept advice. Methods: Five focus group interviews were undertaken with 21 health professionals from North Midlands, UK. Data were analysed using a thematic analysis drawing on the techniques of grounded theory. Findings: Chronic disease management has been delegated to Practice Nurses in many cases leaving some nurses feeling unsupported and some General Practitioners feeling deskilled. Problems with communication, a lack of adequate and timely local service provision, a difficult referral process, time pressures and lack of information were barriers to health care professionals making an offer of pulmonary rehabilitation. An explanatory model is proposed to describe how addressing barriers to referral may improve health care professionals views about pulmonary rehabilitation and therefore may mean that they present it in a more positive manner.

The lived experience of women victims of intimate partner violence

Open access publishing has expanded dramatically over the last decade. For the most part, this works to everyones advantage, enabling important, cutting-edge science to get to readers sooner than by more traditional publication methods. JAN supports open access initiatives including its periodic Virtual Issues program and providing a full open access publication option. Many journals and respectable publishing houses offer similar choices and there are also open-access-only publishers whose publishing standards match those of JAN. However, this is not the case for all open access only publishers.