A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective.

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.

Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65.

INTRODUCTION: The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number and type referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult. METHODS: We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. We described trends in the number, rate, age, mental health presentation, and time taken to assessment over a 7 years period. RESULTS: Referral data from 28 EDs across England and Scotland were analysed (n = 18,828 referrals). There was a general trend towards increasing numbers of people referred to liaison psychiatry year on year. Variability in referral numbers between different departments, ranged from 0.1 to 24.3 per 1000 ED attendances. The most common reasons for referral were mood disorders, self-harm and suicidal ideas. The majority of referrals were assessed within 60 min, however there is variability between departments, some recording waits over 11 h. DISCUSSION: The data suggests great inter-departmental variability in referral numbers. Is not possible to establish the cause of variability. However, the data highlights the importance of asking further questions about why the differences exist, and the impact that has on patient care.

Incontinence pad absorption and skin barrier creams: a non-patient study.

Exposure of the skin to excessive moisture, such as in cases of incontinence, can damage its natural barrier function and lead to tissue damage and breakdown. Common methods for managing incontinence and preventing related skin damage include the use of incontinence pads and the application of skin barrier creams to reduce exposure to moisture and irritants. Previous reports have indicated that barrier creams can transfer onto incontinence pads from the skin and reduce their absorbency, and thus the efficacy of both products. This study, using non-patient volunteers, investigated the effect on incontinence pad absorbency of Medi Derma-S and Medi Derma-Pro; two products from the Medi Skin Protection range, in comparison with other market-leading products. Results indicated that, while there was a small degree of product transfer onto the incontinence pads, this did not have a major impact on the absorption of synthetic urine. Medi Derma-S and Medi Derma-Pro performed consistently with other similar market-leading products.

New Surfactant-based Dressing Product to Improve Wound Closure Rates of Nonhealing Wounds: A European Multicenter Study Including 1036 Patients.

OBJECTIVE: A new surfactant-based biomaterial containing the antimicrobial 1% silver sulfadiazine (SSD) was developed at the University of Virginia (Charlottesville, VA) to improve outcomes for nonhealing wounds. This study's objective was to clinically test the wound care outcomes of the new surfactant-based antimicrobial wound dressing (SAWD) in a multicenter trial. METHODS AND MATERIALS: This cohort study enrolled 1036 patients with any nonhealing wound of > 3 months duration not responding to standard-of-care treatments from 10 wound care centers in 7 European countries. The SAWD was used for all wound types at all stages of complexity, healing, and severity. Data collection ranged from 6 months to 2 years and measured the percentage of patients achieving wound closure and time to complete closure. RESULTS: Of the 1036 patients, 70% achieved wound closure, 24.6% were still in treatment at data collection, and 5.4% had a therapy change. The majority (56%) of these non-healing wounds achieved wound closure within 11 weeks. Patients were treated with the SAWD for 3 weeks to more than 1 year with no complications or adverse effects from long-term SSD antimicrobial use. CONCLUSION: Ten centers concluded that the new SAWD provided positive results (improved wound closure rates, reduction of inflammation, pain, and odor), improvements in clinical application (faster and easier dressing change), and improved patient compliance.

Management of incontinence-associated dermatitis with a skin barrier protectant.

The skin performs many important protective functions, one of which is to act as a barrier to moisture, irritants and bacteria. Good management of patients' skin is a fundamental part of nursing care to prevent development of complex and distressing problems, such as pressure ulceration and incontinence-associated dermatitis (IAD). IAD is skin breakdown related to faecal and/or urinary incontinence, which requires adoption of a structured skin care regimen, including regular skin inspection, cleansing and the use of skin barrier protectants, to proactively protect the skin from irritant bodily fluids. Six case studies using Medi Derma-S skin barrier protectants on patients with IAD highlighted the potential for improved clinical outcomes on skin either vulnerable or compromised due to the effects of incontinence. Positive observations were noted with regard to improvement in skin condition, pain and discomfort, promotion of independence and prevention of deterioration of concurrent pressure damage.

Clinical Evaluation of a Novel Topical Negative Pressure Device in Promoting Healing in Chronic Wounds.

Aim: This observational study evaluated the use of a novel, ultraportable, mechanically powered topical negative pressure device in promoting healing in chronic wounds, including venous and mixed etiology leg ulcers and neuropathic foot ulcers. Materials and Methods: Evaluable patients (n=37) received treatment with the SNaP® Wound Care System for up to 6 weeks. The primary objective was percentage change in wound size, with secondary objectives of clinical assessment of wound parameters, ease of use, and impact on quality of life. Results: A 42.64% mean percentage decrease in wound area was observed, with an overall decrease for each wound etiology subgroup. Increased granulation tissue, decreased exudate levels, and decreased wound pain were reported. Quality-of-life scores increased overall, and the device was easy to use, comfortable, portable, and inconspicuous. Conclusion: The SNaP Wound Care System has the potential to promote healing in chronic wounds of different etiologies.

Persistent sensitisation to the locomotor activating effects of MDMA following MDMA self-administration in rats.

Effects of MDMA exposure on MDMA-produced hyperactivity are dependent on the exposure regimen; high-dose exposure produced tolerance whereas repeated, intermittent exposure produced sensitised responses. In the present study we measured the impact of MDMA self-administration on MDMA-produced hyperactivity. Rats self-administered a total of 165mg/kg MDMA during daily 2h sessions. Control rats self-administered vehicle solution and were matched to the MDMA self-administering rats so that they had the same number of daily exposures to handling and the chamber. Behavioural measures were collected either 5 or 14days following the last MDMA self-administration session and 14days following the last vehicle self-administration session. Following a 30min habituation period, rats received an injection of MDMA (10.0mg/kg, IP) and various measures of MDMA-produced hyperactivity were measured. Speed of forward locomotion and rearing, behaviours that are often attributed to dopaminergic mechanisms, increased following both abstinence periods. These data are consistent with a persistent sensitisation of dopamine substrates as a result of MDMA self-administration.

Acquisition of MDMA self-administration: pharmacokinetic factors and MDMA-induced serotonin release.

The current study aimed to elucidate the role of pharmacokinetic (PK) parameters and neurotransmitter efflux in explaining variability in (±) 3, 4-methylenedioxymethamphetamine (MDMA) self-administration in rats. PK profiles of MDMA and its major metabolites were determined after the administration of 1.0 mg/kg MDMA (iv) prior to, and following, the acquisition of MDMA self-administration. Synaptic levels of 5-hydroxytryptamine (5HT) and dopamine (DA) in the nucleus accumbens were measured following administration of MDMA (1.0 and 3.0 mg/kg, iv) using in vivo microdialysis and compared for rats that acquired or failed to acquire MDMA self-administration. Effects of the 5HT neurotoxin, 5,7 dihydroxytryptamine (5, 7-DHT), on the acquisition of MDMA and cocaine self-administration were also determined. In keeping with previous findings, approximately 50% of rats failed to meet a criterion for acquisition of MDMA self-administration. The PK profiles of MDMA and its metabolites did not differ between rats that acquired or failed to acquire MDMA self-administration. MDMA produced more overflow of 5HT than DA. The MDMA-induced 5HT overflow was lower in rats that acquired MDMA self-administration compared with those that did not acquire self-administration. In contrast, MDMA-induced DA overflow was comparable for the two groups. Prior 5,7-DHT lesions reduced tissue levels of 5HT and markedly increased the percentage of rats that acquired MDMA self-administration and also decreased the latency to acquisition of cocaine self-administration. These data suggest that 5HT limits the initial sensitivity to the positively reinforcing effects of MDMA and delays the acquisition of reliable self-administration.

Repeated exposure to MDMA and amphetamine: sensitization, cross-sensitization, and response to dopamine D1- and D2-like agonists.

RATIONALE: Acute exposure to (±) 3, 4-methylenedioxymethamphetamine (MDMA) produces hyperlocomotion that is preferentially expressed in the periphery of closed chambers. Following repeated administration, however, a sensitized hyperlocomotor response is preferentially expressed in the center of an activity box, so that the response resembles the more generalized activity that is produced by D-amphetamine (AMPH). OBJECTIVES: The present study was designed to determine whether common neuroadaptations underlie the acute and sensitized responses to MDMA and AMPH. METHODS: Rats were pretreated with five daily injections of MDMA (10.0 mg/kg), AMPH (2.0 mg/kg), or saline. Following a 2-day drug-free period, dose-response curves for hyperactivity produced by MDMA (2.5-10.0 mg/kg), AMPH (0.5-2.0 mg/kg), SKF-81297 (1.0-2.0 mg/kg), or quinpirole (0.25-1.0 mg/kg) were obtained. RESULTS: Effects of MDMA and AMPH were increased by pretreatment with both drugs. The sensitized response following MDMA exposure was preferentially expressed in the center compartment, but, following AMPH pretreatment, the sensitized response was observed in both compartments. Cross-sensitization was unidirectional; AMPH pretreatment failed to sensitize to the effects of MDMA, but MDMA pretreatment sensitized to the effects of AMPH. MDMA and AMPH pretreatment produced marginal increases in the effects of SKF-81297. The response to quinpirole was, however, greater following MDMA, but not AMPH, pretreatment. CONCLUSIONS: These data suggest that repeated MDMA exposure produces sensitization via a unique neurochemical effect.