Stephen Thomas

The development of a novel technique for predicting the exudate handling properties of modern wound dressings

Numerous methods have been developed for measuring the absorbency of wound dressings but many are product specific and do not permit comparisons between different dressing types. Existing methods are also of limited value when assessing how a dressing is likely to perform in clinical practice. A new wound model has been developed that overcomes both of these problems. It facilitates direct comparisons between products that are different in structure and composition and provides, perhaps for the first time, a method that may be used to predict the time for which dressings might be expected to remain effective on exuding wounds. The historical background to the introduction of test methods for surgical dressings is briefly reviewed, and the development of the new wound model is described. Some preliminary results that illustrate the potential value of this new technique are also presented.

The cost of wound care in the community

Prescriptions issued between July 1993 and June 1994 for wound management materials cost the NHS in Wales a total of 5.5 million pounds. A detailed analysis of Welsh PACT (prescribing analysis and cost) data suggests that this expenditure could be reduced by up to 140,000 pounds by the introduction of minor changes in prescribing patterns. These savings would be achieved with no reduction in the quality of care provided to patients, and in some instances the changes proposed would lead to the use of products which are superior in performance terms to those items that are currently being prescribed. More fundamental changes, involving the exclusion of some products of questionable efficacy, would result in additional savings up to a maximum of 527,000 pounds. As expenditure in Wales is generally considered to represent approximately 10% that of the UK as a whole, this figure could approach 5 million pounds on a national basis.

Wound Cleansing — A Therapy Revisited

Summary The use of blowfly maggots for wound debridement has been apparent in the past, disappeared with the advent of antibiotics but is now making a comeback. An 82 year-old diabetic developed a deep pressure sore on his elbow following amputation of lower left leg complicated by a cardiac arrest. The wound was sloughy and infected with MRSA; cellulitis, wound tenderness and a pyrexia were also present. A 48 hour, single application of sterile maggots completely debrided the wound revealing a previously unsuspected narrow sinus, the likely seat of the infection. Swabs taken after application of maggots were negative for MRSA and both local and systemic signs of infection had now disappeared. The patient reported no unpleasant reactions to the maggots. The wound was subsequently dressed with hydrocolloid and healed uneventfully.

Observations on Mattress Covers: Results of a Pilot Study

Samples of covers from three commercially available mattresses were examined in the laboratory using test methods originally devised for testing surgical dressings. These revealed that although the covers shared many common features, there were differences in the conformability and tensile properties which may be of some clinical relevance. The study also confirmed that with some minor modifications, the experimental techniques used would be suitable for a future, more comprehensive review of mattress performance. In a separate investigation designed to examine the consequences of a failure of a mattress cover, the bioburden of a foam core removed from a damaged cover revealed the presence of very large numbers of microorganism, well in excess of 10(10) per gram of foam which could act as a recevoir of contamination and thus a source of cross infection.

Nurses and the obesity plan.

I have joined a slimming club. Despite the encouragement, the education and the peer support, it is a slow struggle to lose weight.