Informal carers and wound management: an integrative literature review.

OBJECTIVE: The consequences of informal care giving have been well documented in recent decades, and in many fields of illness and chronic disease, the role of informal carers has been recognised and investigated. Informal caregivers in the field of wound management and prevention have been largely unnoticed, despite the chronic nature of many wounds, the enduring nature of treatments and the impact on the physical and social environment; factors likely to have a significant impact on family and friends. The aim of this study was to consider what published evidence is available regarding the experience and role of informal caregivers in wound management or prevention. METHOD: An integrated literature review was completed in October 2014 searching ESBCOhost database, Wound Management Association websites, and reviewing reference lists of accessed papers. RESULTS: A number of challenges were noted in accessing information about informal carers in relation to wound management and prevention. Most of these arose from the scarcity of studies for which informal carers was the primary focus. The available evidence suggests that informal carers have a role in wound management and prevention and that their involvement is likely to represent a noteworthy economic contribution to the wound management health-care team. Wound management was also determined to yield physical and psychological impacts for the carer. There was limited evidence of structured information, support or training for informal carers, which was flagged by carers as an area of need. CONCLUSION: General conclusions about the burdensome experience and the valuable role of carers were the main interpretations possible from the evidence. More research which purposively and comprehensively examines the experience and role of informal caregivers is required. This knowledge would provide a foundation upon which interventions and support for informal carers and patients can be generated, which could further serve to enhance wound healing and the prevention of skin damage.

UK national guideline on safer sex advice.

This guideline provides evidence-based guidance on the content of safer sex advice and the provision of brief behaviour change interventions deliverable in genitourinary (GU) medicine clinics. Much of the advice is applicable to other healthcare settings including general practice and clinics providing HIV care. Advice on condom use and effectiveness, oral sex and other sexual practices, testing for sexually transmitted infections (STI) and partner reduction is provided. Advice specific to the transmission of HIV infection including seroadaptive behaviours and negotiated safety is also included. An accompanying review of the evidence supporting the guideline with a complete reference list is available online. A patient information leaflet based on the advice statements developed is also available through the BASHH website.

Predicting concordance with multilayer compression bandaging.

OBJECTIVE: To examine the relationship between concordance with multilayer compression bandaging and a number of client and wound characteristics, including wound severity, health status and client independence with respect to activities of daily living. METHOD: Using data gathered for a randomised controlled trial that compared two types of antimicrobial dressings on infected or critically colonised lower leg ulcers, we explored the level of concordance with compression therapy by patients with wounds that had an ankle brachial pressure index of between 0.8 and 1.2. RESULTS: A logistic regression analysis found that increased pain and wound size, older age and shallow wound depth were all significant predictors of non-concordance with multilayer compression bandaging. CONCLUSION: Although the results suggest that pain, wound size, age and wound depth are all significant predictors of non-concordance with multilayer bandaging, the generalisability of these results is limited, given that data were gathered in the context of a RCT. Further studies are required to explore the relative contribution of predictors of concordance with compression therapy, in order to help inform strategies that promote it and, thereby, optimise healing. CONFLICT OF INTEREST: None.

The path to adoption for children of color.

OBJECTIVE: This article focuses on the path to adoption for children involved in the public child welfare system. METHOD: Descriptive and event history analyses were conducted of 1,550 children who had been removed from their homes and placed in out of home care in the child welfare system in Kansas and have adoption as a goal. RESULTS: African American children consistently took longer to reach significant milestones, including adoption placement and finalization. CONCLUSION: African American children are over-represented throughout the progression from substantiated abuse to adoption. Future research in other states should focus on whether this trend is unique to Kansas or applicable in other states. Additionally, efforts should be devoted to investigating the social, psychological, cultural, and systemic factors contributing to this differential treatment. Finally, there is a dire need to develop and evaluate interventions targeted at meeting the specialized needs of African American children in this system.

Transfemoral socket design and suspension options.

The transfemoral socket is the interface between the patient's residual limb and the remaining prosthesis. Whether the patient uses a technologically advanced knee mechanism and foot or a single axis, constant friction knee and solid ankle cushioned heel, no other prosthetic component is as crucial in assuring a comfortable and well-functioning prosthesis as the socket. This article discusses the rationale of quadrilateral and ischial containment socket designs and reviews suspension options.

Suspension systems for prostheses.

The appropriate suspension system results in a safe and well functioning lower extremity prosthesis. Residual limb length, joint ligament stability, and limb volume determine suspension methods as does activity level, dexterity, success of previous suspension, and cosmetic requirements. The supracondylar suspension cuff, prosthetic sleeves, and gel liners with locking mechanisms generally are indicated for the average to long transtibial amputation level. Short limbs are better fitted with supracondylar and suprapatellar suspension. Waist belts generally are indicated for patients with new amputations or those with vascular compromise. Suction suspension is the most desirable form of transfemoral suspension and is recommended for most standard to long residual limbs. Roll on silicone liners with or without locking pins and the hyperbaric sock offer the patient systems that are easier to don yet still provide unencumbered suspension. The total elastic suspension belt offers excellent auxiliary suspension and can be applied to the prosthesis by the patient. Multiple factors and patient preference should be considered when prescribing suspension systems for lower extremity prostheses.

Gastrointestinal disease: nutritional implications.

The management of patients with gastrointestinal disease must include attention to nutritional status. It has been documented that morbidity and mortality previously considered common in these patients can be reduced significantly. Perhaps the largest contribution that advances in nutritional support have made is the reduction in the frequency of surgical intervention. Remission of inflammatory bowel disease, closure of fistulas, intestinal adaptation, and prevention of malnutrition in complicated pancreatitis with the use of nutritional therapies help to avoid the complications of operative procedures.

Psychosocial aspects of nutritional support.

The relationship between an individual's social, psychological, and cultural environment and his or her nutritional status is one of both cause and effect. Cultural patterns, economic stability, and attitudes toward health and disease all affect an individual's eating behavior. Similarly, illness or treatments that interfere with usual nutritional behaviors can affect an individual's emotional well-being and social relationships. We have discussed some of the symbolic and social meanings of food and have described how these are challenged by the necessity for "artificial feedings." We have suggested that an understanding of the interaction among the cultural and social factors involved in eating is important in helping to provide comprehensive care to patients requiring nutritional intervention as part of treatment for a medical or surgical disease. In addition, we have presented a description of anorexia nervosa as an example of an illness in which the primary symptoms involve the use of deviant eating behaviors as a way to meet psychological needs. The psychosocial context of food and of obtaining nutrition seem in many ways to be quite obvious, but we must make a conscious effort not to take for granted or to overlook the impact the psychological, social, and cultural environment has upon our patients receiving nutritional therapies.

Significance of hyperlactatemia in acute hypnotic drug poisoning.

Lactate concentration, fibrinogen and fibrin(ogen) -- degradation-products in central venous blood were analysed in 35 unconscious patient with acute hypnotic drug poisoning (HDP) and compared with the results in 13 healthy control persons undergoing the same degree of forced diuresis via central venous catheters. Blood samples were taken on admission and at 12 h intervals up to 36 h after admission. Patients with HDP were attributed to the categories of moderate intoxications (n = 17) and severe intoxications (n = 18) according to their clinical condition. On admission, blood lactate was significantly higher in severe intoxication (3.90 +/- 2.94 mmol/l) as compared to the control group (1.25 +/- 0.17 mmol/l). Blood lactate was less elevated in moderate poisoning (2.74 +/- 1.22 mmol/l). Thirty-six hours after admission blood lactate was completely normalised in patients with moderate intoxication (1.19 +/- 0.69 mmol/l) but still significantly elevated in severely poisoned patients (2.26 +/- 1.48 mmol/l). Lactate concentration was above normal in 15 out of 17 patients with moderate and in 17 out of 18 patients with severe poisoning. A statistically significant linear correlation existed between the duration of unconsciousness and the maximal lactate concentration within 12 hrs after admission. For fibrinogen concentrations statistically significant differences were observed neither between groups nor across time. Titers of FDP were elevated in 9 out of 11 patients with moderate and to a higher degree in all patients with severe poisoning, indicating low rate DIC. Hyperlactatemia is a frequent finding in acute hypnotic drug poisoning. Blood lactate estimations may improve the evaluation of the severity of poisoning and the efficacy of therapeutic interventions.

[Special aspects of fracture healing in cranio-cerebral injuries]. / Spezielle Aspekte der Frakturheilung beim Schädelhirnverletzten.

This study demonstrates the changes of concentration and elimination of calcium, phosphate and zinc, as well as alteration of serum alkaline phosphatase and acid phosphatase especially in patients with severe brain injuries in connection with bone fractures. Because the study has not been completed, the presently acquired results should only demonstrate possible development of the examined parameters. To find out the pathogenesis of overgrowing callus in brain-injured patients, further examinations are being carried out to find the histochemical activities of alkaline and acid phosphatase, lactate dehydrogenase, adenosine triphosphatase and acetylcholine esterase.

[Isoenzymes of creatine kinase: distribution in the skeletal muscle and in sera of patients with muscular diseases or damages (author's transl)]. / Isoenzyme der Kreatin-Kinase: Verteilungsmuster in der Skeletmuskulatur und im Serum bei Erkrankungen sowie Schädigungen der Muskulatur.

In skeletal muscle isoenzymes of CK were determined by immunprecipitation and chromatography. The activity of CK-MB was between 17 and 47 U/g muscle, corresponding to a quota between 2,1 and 4,2% of the total activity. In sera of patients with muscular dystrophy, polymyositis, hypothyroidism, after arterial embolism, epilepsy, hyperventilation, operations and polytrauma with and without injury to the thorax isoenzymes were measure by immune precipitation- and immune inhibition-test. The percentage of CK-MB in all sera was less than 6% of the total CK-activity (range: 0 to 6%). Only patients in the first day after neurosurgical operations showed a quota till to 6.5% CK-MB. In serum of patients after polytrauma without injury to the thorax the percentage of CK-MB ranged from 0-5.7% while after polytrauma with injury to the thorax and a reasonable suspicion of a damage to the myocardium this quota was between 5.1 and 23.6% of the total activity. CK-BB activity was not detectable in any cases. Therefore a disease or damage of the skeletal muscle is more probable, if the percentage of CK-MB in less than 6%, because in sera of patients with myocardial infarction in the first 48 h after beginning of the symptoms this quota of CK-MB in the most cases in more than 6%.

[Comparative methods for the determination of the activity of serumcholinesterases (acylcholin-acyl-hydrolase E.C. 3.1.1.8) and their diagnostical value (author's transl)]. / Vergleich von Methoden zur Aktivitätsbestimmung der Serumcholinesterasen (Acylcholin-acylhydrolase E. C. 3.1.1.8) und deren diagnostische Wertigkeit

The activities of serum cholinesterases were determined in parallel with acetyl-, butyryl- and propionyl-thiocholiniodide in healthy persons and patients with acute and chronic hepatitis, cirrhosis of the liver, fatty liver, cholestasis, intoxication and malignant tumors. The following normal values were obtained: See Article. The correlations between the various methods, especially between butyryl- and propionylthiocholiniodide are statistically significant. Compared to healthy persons, the activity of serum-cholinesterases, determined with the three substrates, decreased significantly in patients with acute and chronic hepatitis, cirrhosis of the liver, intoxication and malignant tumors. A change of specificity of serum-cholinesterases towards acetyl-, butyryl- and propionylthiocholiniodide in normal persons and patients with endogenous or exogenous coma of the liver was not observed. In all cases a parallel decrease of activity in sera was determined.