Holistic management of malignant wounds in palliative patients.

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.

Professional caregivers' knowledge in dermatology : Improving knowledge and communication to dermatologists in geriatric facilities.

BACKGROUND: Research regarding effective collaboration and communication between professional caregivers and dermatologists and the need for further education and training for caregivers in the field of geriatric dermatology still remains relatively scarce. OBJECTIVE: To document the state of knowledge of professional caregivers in the field of geriatric dermatology and make recommendations for dermatological education and postgraduate training. METHODS: A questionnaire with open and closed questions was used to evaluate the level of knowledge and current need for information in geriatric dermatology. A total of 58 professional caregivers from several hospital departments, including geriatric wards and nursing homes participated in this study. Quantitative and qualitative data were generated and responses to open questions were categorized according to the most quoted contents. The study was approved by the Charité University in Berlin ethics committee. RESULTS: The study demonstrates that there is a lack of dermatological knowledge. Participants indicated a huge information need regarding skin tumors (77.2 %), prevention of skin diseases (50.0 %) and pruritus (41.4 %). According to the caregivers, communication problems with physicians arise in view of using standardized terms of skin diseases (22.9 %) and formulating unclear care records of skin diseases (20.8 %). CONCLUSION: Difficulties in communication between professional caregivers and physicians can influence patients' punctual and well-founded treatment; therefore, further education must be mediated vividly and practically. Moreover, training should focus on learning standardized terms and descriptions for optimizing the flow of information with physicians and written communication, such as care records.

Diagnosis, treatment and management of epidermolysis bullosa.

Epidermis bullosa is a genetically inherited disease in which painful blistering of the skin or mucous membranes occurs after minor trauma. It is a lifelong problem. The diagnosis should be confirmed by a specialist, preferably at a specialist unit where a treatment plan and follow-up arrangements for professionals and families can be put in place. Nurses will be involved in frequent dressings of wounds, after extra analgesia, and may need to be alert to any need for further specialist referral, especially in the case of complications such as infection, deformities, gastrointestinal strictures and possible skin cancers. Genetic counselling should also be offered to families, especially when considering the possible risks to future pregnancies.

Effects of live saxophone music on physiological parameters, pain, mood and itching levels in patients undergoing haemodialysis.

BACKGROUND: Few studies have focused on the effect of music in patients undergoing haemodialysis. OBJECTIVES: To determine the effects of live saxophone music on various physiological parameters and pain, mood and itching levels. DESIGN: A randomised controlled study with 114 patients undergoing haemodialysis with a control group (n = 57) and an experimental group (n = 57) who received 30 minutes of live saxophone music therapy. MEASUREMENTS: Systolic and diastolic blood pressure, pulse rate, glycaemia, oxygen saturation, pain, mood and itching levels were measured before and after the live music performance, resulting in baseline and post-test values for the patients in the experimental group. RESULTS: The experimental group showed a statistically significant reduction in pain level, and an improvement in mood and itching levels and in the oxygen saturation. CONCLUSION: Live saxophone music could be introduced to improve clinical and quality-of-life measures in patients undergoing haemodialysis.

The effect of aromatherapy on haemodialysis patients' pruritus.

AIMS AND OBJECTIVES: To determine the effect of aromatherapy on pruritus observed in haemodialysis patients. BACKGROUND: Although the prevalence of pruritus in kidney failure has decreased in the recent years, pruritus is a difficult and serious problem which concerns the majority of haemodialysis patents and is hard to cure. DESIGN: A prospective, pretest-post-test quasi-experimental design was used. METHODS: The research is quasi-experimental clinical trial conducted as pretest and post-test with control groups between January 2011-April 2012, in haemodialysis units of hospitals in Erzurum. The collection of the data is achieved using a questionnaire to detect the patients' individual and pruritus score scale and to clarify certain laboratory parameters regarding the pruritus. Chi-square analysis and t-test are used for the analysis of data. RESULTS: The experimental group's mean post-test pruritus scores (7·20 ± 3·14) were found to be lower than that of control group patients (10·00 ± 2·47), and a highly significant difference was found between the groups (p < 0·001). In the between-groups comparisons of experimental and control group's laboratory parameters, the experimental group's post-test blood urea nitrogen levels (118·26 ± 36·76) were found to be lower than that of control group patients (138·80 ± 48·69), and the between-groups difference was found to be statistically significant (p < 0·05). CONCLUSIONS: The results demonstrate that aromatherapy was found to decrease the pruritus problem of haemodialyses patients and led to positive changes in some laboratory parameters related to pruritus. RELEVANCE TO CLINICAL PRACTICE: One of the roles of health professionals is to advise individuals, who are living on this problem, using the nonpharmacological methods in checking the itching. By preventing or reducing uraemic pruritus, aromatherapy may also improve quality of life in this patient group.

Efficacy of narrowband ultraviolet phototherapy on renal pruritus.

AIMS AND OBJECTIVES: To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. BACKGROUND: Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. DESIGN: The study was based on a quasi-experimental design with repeated measures. METHODS: A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. RESULTS: The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p < 0·001) at time seven, 1·71 (p < 0·001) at time six and 1·24 at time five (p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation. CONCLUSION: The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus. RELEVANCE TO CLINICAL PRACTICE: Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments.

Linguistic validation of the 5D itching scale to Arabic in patients with end-stage kidney disease.

BACKGROUND: Pruritus is one of the commonest skin complaints in end-stage kidney disease. Pruritus can be effectively managed if proper assessment is carried out to categorise its severity. The objective of this study is to test the reliability of an Arabic version of the 5D-Itching scale (5D-IS). METHOD: A self- administered Arabic version of the 5D-IS was tested for linguistic validation. Language validity of the tool was carried by using the forward/backward method. Internal consistency was tested using Cronbach's alpha and Spearman's rank. Factor analysis was performed to assess the content adequacy of the study tool. FINDINGS: A total of 151 patients completed the survey. The 5D-IS is mainly comprised of five domains that are used to assess the level of itching. The mean ± SD 5-D score obtained in the study group was 12.7 ± 5.3 with scores ranging between 6 and 25. Cronbach's alpha was 0.850 for the five domains of 5 D-IS. The reliability of five domain 5 D-IS indicates the practical applicability of the instrument with inter-correlation of 0.847 (p < 0.05). CONCLUSION: The 5D-IS was found to be a reliable tool for assessing itching in Arabic patients with uraemic pruritus. Due to its simplicity, this tool can easily be used by clinical staff to assess the severity of pruritus.

A cross-sectional study of chronic wound-related pain and itching.

Persons with chronic wounds may experience wound-related itch (pruritus) and pain. A cross-sectional study was conducted to examine the occurrence of itch and pain in chronic wounds and the relationship of the intensity between these factors. Patients in an outpatient wound care center, 18 years and older with an open wound, were recruited consecutively over a 5-month period. The 199 participants (112 [56%] men) had a mean age of 67 years (range 21-98 years); one wound per person was addressed and included venous (31), arterial (23), neuropathic (31), pressure-related (33), traumatic (37), and "other" (41) wounds. Wound-related pain and itch data were obtained using a modified Paul-Pieper Itching Questionnaire and Characteristics of Itch Questionnaire. Responses were hand-recorded and coded without personal identifiers and analyzed using descriptive statistics, and associations among data were assessed using Pearson chi-square, Mantel-Haenszel chi-square, and Cochran-Armitage trend tests. Wound-related itch was significantly associated with participant age (P = 0.011) and employment status (P = 0.003). Wound-related pain was significantly associated only with education level (P = 0.048). Persons with venous wounds had both the largest proportion with wound-related itch (45.2%) and the largest proportion with wound-related pain (61.2%) out of all of the wound types. Persons with diabetic neuropathy had both the smallest proportion with wound-related itch (16.1%) and the smallest proportion with wound-related pain (35.4%) among all of the wound types. Associations between wound type and wound-related itch or pain were not significant. When venous wounds were compared to all other wound types combined, wound-related itch was significantly associated (P = 0.021) with wound type - ie, venous wound type and itch was statistically significant when venous wounds were compared to a combination of all other wound types. Wound-related pain and itch occurred together in 35 participants (17.6%) across all wound types. Pain and itch on the wound were significantly associated (r = .36, P = 0.043), as were pain and itch around the wound (r = .43, P = 0.002). Because pain and itching can occur with chronic wounds and the presence of one factor can affect the other, clinicians need to assess and manage both symptoms in patients with wounds.

Obstetric cholestasis (OC).

Obstetric cholestasis (OC) is the most common liver condition specific to pregnancy and affects around 5,000 women in the UK every year. It's generally benign for the mother although the main presenting symptom of pruritus can sometimes be so severe that the woman scratches herself until she bleeds. However, the main concerns are for the fetus, as the condition is associated with an increased risk of fetal distress, spontaneous premature labour and stillbirth. This article aims to provide information about the condition so that as a practising midwife you can offer women sufficient support should OC be suspected or diagnosed.

Diagnosis, treatment and management of pruritus.

Pruritus is a ubiquitous symptom with a wide range of presentations, often causing considerable distress for many individuals and resulting in reduced quality of life. In recent years there has been renewed interest and increased research activity in this previously neglected field. Although there is still much to be learnt about the mechanisms of pruritus, appropriate nursing interventions can be pivotal to the success of treatment. This article focuses primarily on the diagnosis, treatment and management of pruritus resulting from common dermatological causes. Key aspects of effective management of pruritus include individualized management and holistic assessment. The words 'pruritus' and 'itch' are used synonymously in this article.

Care and management of patients with pruritus.

Pruritus is one of the most common skin conditions in older people. People may develop pruritus for many reasons but often it is not possible to diagnose the cause. Pruritus can cause physical and psychological suffering, affecting quality of life. The persistent itch leads to scratching which is a threat to skin integrity. It can also disrupt sleep and affect relationships. Pruritus should be treated actively. It is essential that people with pruritus receive a holistic assessment and that treatment plans are negotiated to maximise concordance and thus effective outcomes.

Practical issues for emollient therapy in dry and itchy skin.

Managing atopic eczema and other dry and itchy skin conditions is a skill required in all nursing specialties. Nurses need to assess and address their patients' skin-care needs. Atopic eczema and all dry and itchy skin conditions require emollient therapy to restore the skin barrier. Nurses are ideally placed to educate patients in the importance of emollient therapy and provide practical information on the individual selection of bath additives, soap substitutes and moisturizers, as well as education on application and self-management. Nurse prescribers will benefit from understanding specific individual patient needs and individual emollient properties to enable them to make informed prescribing decisions and foster patient choice in selecting the best emollient therapy for the individual. This will restore the skin barrier function, reduce itch and suit the patient.

Managing pruritus in the older person.

As one's skin ages, pruritus becomes a significant problem where one's skin becomes more vulnerable to the impact of underlying systemic disease, and dermatological conditions become much more common. This article briefly reviews the most common causes and treatments for pruritus. It then focuses on topical management, giving practical tips on skin care that can help to alleviate the condition. The key role of community nurses working in primary care is emphasized, with discussion of how best to motivate and maintain concordance in the independent patient.

Correlating an 11-point verbal numeric rating scale to a 4-point verbal rating scale in the measurement of pruritus.

Pruritus, the subjective sensation of itch, can be a difficult symptom to assess and treat. Evaluating levels of patient discomfort across populations has proven to be challenging because of a lack of a standardized measurement tool to quantify levels of itch. The most widely used tool is the 4-point verbal rating scale (VRS-4), but others use an 11-point verbal numeric rating scale (VNRS-11). Therefore, the purpose of our study was to correlate a VNRS-11 to a VRS-4 for the assessment of pruritus. Fifty parturients were enrolled in this correlational study. Each subject's level of pruritus was measured at five specific intervals after administration of intrathecal opioids. The scales were administered one minute apart in random order. Data analysis demonstrated a strong correlation between these two scales, (r=.910 to .853) indicating that each verbal descriptor on the VRS-4 could readily be substituted with a quantifiable range on the VNRS-11.

Management of skin conditions in the older population 2.

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.