Patient-reported experience with the use of Mepitel Film for prevention of acute radiation dermatitis in breast cancer.

BACKGROUND AND PURPOSE: Mepitel Film (MF) has been demonstrated to reduce the severity of radiation dermatitis (RD) in patients receiving breast cancer radiotherapy (RT). The objective of this study was to characterize patient-reported experience with MF use, including its impact on daily activities and wellbeing. MATERIALS AND METHODS: This single-institution study analyzed anonymized responses to a questionnaire completed by patients who used MF for the prevention of RD during breast cancer RT. RESULTS: Of the 254 patients contacted, 192 patients completed the survey. Most patients disagreed or strongly disagreed that MF limited their ability to perform their daily activities, including household chores (88%, n = 169/191), their ability to work (83%, n = 157/189), or their ability to sleep (85%, n = 163/191). Furthermore, patients agreed or strongly agreed MF was comfortable on their skin (67%, n = 126/189) and protected their skin from rubbing against clothing (86%, n = 161/188). Some patients agreed or strongly agreed that MF affected their ability to shower (31%, n = 50/162), wear bras (28%, n = 51/185), and impacted their level of pruritus (35%, n = 67/189). However, most patients agreed or strongly agreed that their overall experience with MF was positive (92%, n = 173/189) and would recommend MF to a friend undergoing breast cancer RT (88%, n = 166/188). CONCLUSION: MF use is associated with positive patient-reported experience during breast RT with minimal impact on daily activities.

Perceptions of healthcare professionals on the use of Mepitel Film for the prevention of acute radiation dermatitis in breast cancer.

INTRODUCTION: Randomized clinical trials support Mepitel Film (MF) as a prophylactic treatment for radiation dermatitis (RD) in patients undergoing breast radiotherapy. Although several studies have canvassed the opinion of patients on using MF, no such studies have been done to investigate the perception of healthcare professionals (HCPs). The objective of this study was therefore to investigate the perceptions of HCPs on MF as a treatment option for RD. METHODS: Anonymized responses to a web-based survey sent to HCPs at a single institution managing patients using MF during breast radiotherapy were analyzed. RESULTS: Of the 28 HCPs contacted, 22 completed the survey, including 6 radiation oncologists (ROs), 11 radiation therapists (RTTs), and 5 nurses. Most HCPs reported MF was better at preventing severe RD than the standard of care and improved radiation-induced skin reactions (n = 20/22, 91%, and n = 19/22, 86%, respectively). MF was recommended for mastectomy patients without reconstruction (n = 15/21, 71%). The majority of HCPs believed that patients' families could be trained to apply and remove MF (n = 19/22, 86%). Many HCPs perceived that implementation of MF would be difficult in terms of maintaining patient flow and wide-scale implementation within their institution (n = 11/22, 50%, and n = 10/22, 46%, respectively). Most HCPs perceived that fewer than 50% of their patients could afford MF if priced at $100 CAD (n = 15/20, 75%). CONCLUSION: These findings provide insights into the possibility of MF to be incorporated into standard practice of care for RD. Although most HCPs were satisfied with MF as a prophylactic treatment for RD, there are concerns about its resource-intensive operationalization and financial accessibility to patients. Future research should focus on ways to improve HCP experience with MF and to improve its implementation into clinical settings as standard of care.

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series.

BACKGROUND: Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. CASES: Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. CONCLUSIONS: For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.

Safeguarding pollinators and their values to human well-being.

Wild and managed pollinators provide a wide range of benefits to society in terms of contributions to food security, farmer and beekeeper livelihoods, social and cultural values, as well as the maintenance of wider biodiversity and ecosystem stability. Pollinators face numerous threats, including changes in land-use and management intensity, climate change, pesticides and genetically modified crops, pollinator management and pathogens, and invasive alien species. There are well-documented declines in some wild and managed pollinators in several regions of the world. However, many effective policy and management responses can be implemented to safeguard pollinators and sustain pollination services.

Preoperative stoma site marking for fecal diversions (ileostomy and colostomy): position statement of the Canadian Society of Colon and Rectal Surgeons and Nurses Specialized in Wound, Ostomy and Continence Canada.

BACKGROUND: Every year, about 13 000 Canadians undergo an ostomy procedure, which requires stoma site marking to create a well-constructed stoma and prevent stoma-related complications. The Canadian Society of Colon and Rectal Surgeons (CSCRS) and Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) created a position statement to provide evidence-based guidance and techniques for stoma site selection. METHODS: A task force was formed comprising 20 health care professionals (7 colorectal surgeons from the CSCRS and 13 nurses from NSWOCC) with representation from across Canada. A literature review was performed, with the following databases searched from January 2009 to April 2019: MEDLINE, Embase, Cochrane, PubMed, CINAHL and Google Scholar. After the abstracts were screened, 6 task force members created a draft version of the position statement from the articles retained after full-text review. The draft was submitted to the entire task force for comments, and the ensuing modifications were incorporated. Peer reviewers were then recruited from the CSCRS and NSWOCC; a summary of their comments was reviewed by the task force, and modifications were incorporated to produce the final document. RESULTS: The literature search identified 272 papers, of which 58 were reviewed after duplicates were excluded. After full-text review, 18 papers were included to guide the position statement. From these papers, we created a series of 17 steps for stoma site marking. Four general principles were found to be important for stoma site marking: obtain informed consent, identify important patient factors and landmarks, assess the abdomen and mark the most appropriate location. A 1-page enabler document and video were created as teaching aids and to help with dissemination of the information. CONCLUSION: This position statement, associated enabler document and video provide evidence-based guidance for stoma site marking in both emergency and elective settings, and should be used by surgeons and nurses specialized in wound, ostomy and continence to identify optimal stoma sites preoperatively.

Prospective Multicenter Evaluation of an Advanced Extracellular Matrix for Wound Management.

OBJECTIVE: To evaluate an advanced extracellular matrix made of ovine forestomach matrix (OFM) for healing a variety of wound types. METHODS: Participants were enrolled from inpatient, outpatient, and home healthcare settings. The OFM was used to treat all wounds and applied to the wound bed every 3 to 7 days until closure. RESULTS: Researchers enrolled 29 participants with 33 wounds. Average time to wound closure was 8.2 weeks, the percentage of wounds that reduced in size by 50% or more at 4 weeks was 64%, the average wound area reduction at 4 weeks was 66%, and 73% of wounds had closed at 12 weeks. No adverse effects were observed. CONCLUSIONS: This represents the first Canadian evaluation of OFM for the treatment of wounds, and the positive healing outcomes observed could support more widespread adoption of this matrix.

Technological features of advanced skin protectants and an examination of the evidence base.

Products that provide a protective skin barrier play a vital role in defending the skin against the corrosive effect of bodily fluids, including wound exudate, urine, liquid faeces, stoma output and sweat. There are many products to choose from, which can be broadly categorised by ingredients. This article describes the differences in mechanisms of action between barrier products comprising petrolatum and/or zinc oxide, silicone film-forming polymers and cyanoacrylates, and compares the evidence on them. The literature indicates that all types of barrier product are clinically effective, with little comparative evidence indicating that any one ingredient is more efficacious than another, although film-forming polymers and cyanoacrylates have been found to be easier to apply and more cost-effective. However, laboratory evidence, albeit limited, indicates that a concentrated cyanoacrylate produced a more substantial and adherent layer on a porcine explant when compared with a diluted cyanoacrylate and was more effective at protecting skin from abrasion and repeated exposure to moisture than a film-forming polymer. Finally, a silicone-based cream containing micronutrients was found to significantly reduce the incidence of pressure ulceration when used as part of a comprehensive prevention strategy.

Exploring sustainable land use in forested tropical social-ecological systems: A case-study in the Wet Tropics.

Tropical countries lie at the nexus of three pressing issues for global sustainability: agricultural production, climate change mitigation and biodiversity conservation. The forces that drive forest protection do not necessarily oppose those that drive forest clearance for development. This decoupling, enhanced by the stronger economic forces compared to conservation, is detrimental for the social-ecological sustainability of forested tropical landscapes. This paper presents an integrated, and spatially-explicit, Agent-Based Model that examines the future impacts of land-use change scenarios on the sustainability of the Wet Tropics region of tropical Queensland, Australia. In particular, the model integrates Bayesian Belief Networks, Geographical Information Systems, empirical data and expert knowledge, under a land-sharing/land-sparing analysis, to study the impact of different landscape configurations on trade-offs and synergies among biodiversity and two ecosystem services (sugarcane production and carbon sequestration). Contrary to most tropical regions, model simulations show that Business As Usual is helping to reconcile these contrasting goals in the forested landscape of the Wet Tropics. The paper analyses which combination of governance and socio-economic factors is causing these positive results. This is an outstanding achievement for a tropical region, considering that most tropical areas are characterized for having stronger economic-land clearing forces compared to conservation forces, which reduce important ecosystem services for human wellbeing and the health of ecosystems.

Effect of a surfactant-based gel on patient quality of life.

The characteristic clinical signs of chronic wounds, which remain in a state of prolonged inflammation, include increased production of devitalised tissue and exudate, pain and malodour. The presence of necrotic tissue, slough and copious exudate encourages microbial proliferation, potentially resulting in planktonic and/or biofilm infection. For patients, the consequences can include leakage of exudate, pain and reduced mobility, which can impair their ability to socialise and perform activities of daily living. This can severely reduce their quality of life and wellbeing. Concentrated surfactant-based gels (Plurogel and Plurogel SSD) are used in wound cleansing to help manage devitalised tissue. In vitro studies indicate they can sequester planktonic microbes and biofilm from the wound bed, although there is, limited clinical evidence to support this. A group of health professionals who have used this concentrated surfactant gel, in combination with standard care, in their clinical practice for several years recently met at a closed panel session. Here, they present case studies where topical application of these gels resulted in positive clinical outcomes in previously long-standing recalcitrant wounds. In all cases, the reduction in inflammation and bioburden alleviated symptoms that previously severely impaired health-related quality of life and wellbeing.

Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations.

OBJECTIVE: Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN: A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations. A literature search was conducted to provide a brief review of the peer-reviewed studies published between January 2000 and March 2016 to inform the meeting. SETTING: A 2-day panel meeting convened in February 2017. PARTICIPANTS: Healthcare providers with experience using ORC/collagen dressings. This multidisciplinary panel of 15 experts in wound healing included podiatrists, wound care specialists (doctors, certified wound care nurses, and research scientists), and an orthopedist. RESULTS: The literature search identified 58 articles, a majority of which were low levels of evidence (69.3% were level 3 or lower). Panel members identified wound types, such as abrasions, burns, stalled wounds, diabetic foot ulcers, and pressure injuries, where ORC/collagen dressing use could be beneficial. Panel members then provided recommendations and technical pearls for the use of ORC/collagen dressings in practice. Barriers to ORC/collagen dressing use were discussed, and potential resolutions were offered. CONCLUSIONS: An ORC/collagen dressing can be a critical tool for clinicians to help manage a variety of wounds. Clinical and economic studies comparing standard-of-care dressings and plain collagen dressings to ORC/collagen dressings are needed.

Towards richer knowledge partnerships between ecology and ethnoecology.

Indigenous and traditional practices based on ethnoecological knowledge are fundamental to biodiversity stewardship and sustainable use. Knowledge partnerships between Indigenous Peoples, traditional local communities, and ecologists can produce richer and fairer understandings of nature. We identify key topical areas where such collaborations can positively transform science, policy, and practice.

In situ conservation of traditional vegetable diversity in Wa homegardens in southwestern Yunnan, China.

BACKGROUND: Homegardens are in situ conservation sources of germplasm diversity for overcoming homogenous germplasm problems in industrial agricultural systems. The Wa people constitute a long-dwelling ethnic group mainly in southwestern Yunnan with a unique culture and rich knowledge of traditional vegetables. We hypothesized that traditional vegetable varieties are well conserved in Wa homegardens because Wa culture promotes the preservation of traditional vegetables. We surveyed vegetable varieties and the practices that are involved in the conservation of traditional vegetables in Wa homegardens, which could form the basis for in situ conservation. METHODS: The methods were used including questionnaires and semi-structured interviews. Sixty homegardens were surveyed through purposive sampling in 6 Wa villages. We documented ethnobotanical information about vegetables in homegardens. Plant species were identified according to the Flora of China. And thematic analyses were conducted for in-depth interviews to identify the conservation factors for traditional vegetables. RESULTS: Fifty-two vegetable species belonging to 16 families and 41 genera were recorded from 60 Wa homegardens. Fifty-five traditional vegetable varieties and thirty-six hybrids were recorded. Among all the villages, 23 ± 6 (average ± SD) traditional vegetable varieties per homegarden and 9 ± 3 (average ± SD) introduced varieties per homegarden were recorded. Local seeds were stored in 78% of households, with an additional 9% of households' seed supplies coming from neighbors and relatives; the other 13% of households purchased local seeds from markets. In 83% of families, the female head was mainly responsible for the decision-making concerning traditional vegetables in homegardens; in 10% of families, the male head was responsible for decision-making, and a small percentage (2%) was determined by elderly people. Five percent of families made decisions jointly between male and female household heads. CONCLUSIONS: This study demonstrated that rich traditional germplasm diversity is harbored in Wa homegardens because of the unique culture and traditional knowledge of Wa communities, which are practiced daily with homegrown food plants. Local vegetable seed conservation and sharing systems help maintain germplasm diversity in the Wa community homegardens. Wa homegardens constitute a practical solution for protecting traditional germplasm diversity and maintaining traditional lifestyles.

A Prospective Multisite Observational Study Incorporating Bacterial Fluorescence Information Into the UPPER/LOWER Wound Infection Checklists.

INTRODUCTION: The UPPER/LOWER infection checklists look for signs and symptoms of local/superficial infection (UPPER) and deep infection (LOWER) to assist clinicians in identifying and distinguishing between these infection levels, facilitating appropriate treatment. The presence of 3 or more UPPER or LOWER criteria is indicative of infection. OBJECTIVE: This study evaluated the utility of incorporating real-time bacterial fluorescence imaging into the UPPER/LOWER checklists to enhance identification of infection in wounds. MATERIALS AND METHODS: This prospective, multisite study assessed 43 chronic wounds. Infection was identified in 27 wounds (62.8%) according to the UPPER/LOWER checklist criteria; 3 wounds were positive for both UPPER and LOWER infection, 1 wound was positive for LOWER infection only, and 23 wounds were positive for UPPER infection only. Fluorescence images were taken to detect wounds with high bacterial loads (> 104 CFU/g), indicated by the presence of red or cyan fluorescence. RESULTS: Red or cyan fluorescence from bacteria was observed in 88% of wounds (n = 38); all wounds positive for UPPER/LOWER were also positive for bacterial fluorescence. In 18 (41.9%) of the 43 wounds, fluorescence information added a third check to the UPPER/LOWER threshold, turning a negative diagnosis into a positive diagnosis of infection. Bacterial load was detected in 22/27 wounds swabbed, 17 of which exhibited heavy growth; in all wounds with detectable bacterial load, fluorescence signal was observed (positive predictive value = 100%, negative predictive value = 83%). Using microbiology as ground truth, inclusion of fluorescence information as an additional item in the checklists increased the sensitivity of the UPPER/LOWER checklist from 82% to 95%. CONCLUSIONS: These results suggest that the UPPER/LOWER checklist and fluorescence imaging work in a complementary manner to effectively identify wounds with high bacterial burden at the point-of-care.

Exploring sustainable scenarios in debt-based social-ecological systems: The case for palm oil production in Indonesia.

A debt-based economy requires the accumulation of more and more debt to finance economic growth, while future economic growth is needed to repay the debt, and so the cycle continues. Despite global debt reaching unprecedented levels, little research has been done to understand the impacts of debt dynamics on environmental sustainability. Here, we explore the environmental impacts of the debt-growth cycle in Indonesia, the world's largest debt-based producer of palm oil. Our empirical Agent-Based Model analyses the future effects (2018-2050) of power (im)balance scenarios between debt-driven economic forces (i.e. banks, firms), and conservation forces, on two ecosystem services (food production, climate regulation) and biodiversity. The model shows the trade-offs and synergies among these indicators for Business As Usual as compared to alternative scenarios. Results show that debt-driven economic forces can partially support environmental conservation, provided the state's role in protecting the environment is reinforced. Our analysis provides a lesson for developing countries that are highly dependent on debt-based production systems: sustainable development pathways can be achievable in the short and medium terms; however, reaching long-term sustainability requires reduced dependency on external financial powers, as well as further government intervention to protect the environment from the rough edges of the market economy.

Understanding Real-Time Fluorescence Signals from Bacteria and Wound Tissues Observed with the MolecuLight i:XTM.

The persistent presence of pathogenic bacteria is one of the main obstacles to wound healing. Detection of wound bacteria relies on sampling methods, which delay confirmation by several days. However, a novel handheld fluorescence imaging device has recently enabled real-time detection of bacteria in wounds based on their intrinsic fluorescence characteristics, which differ from those of background tissues. This device illuminates the wound with violet (405 nm) light, causing tissues and bacteria to produce endogenous, characteristic fluorescence signals that are filtered and displayed on the device screen in real-time. The resulting images allow for rapid assessment and documentation of the presence, location, and extent of fluorescent bacteria at moderate-to-heavy loads. This information has been shown to assist in wound assessment and guide patient-specific treatment plans. However, proper image interpretation is essential to assessing this information. To properly identify regions of bacterial fluorescence, users must understand: (1) Fluorescence signals from tissues (e.g., wound tissues, tendon, bone) and fluids (e.g., blood, pus); (2) fluorescence signals from bacteria (red or cyan); (3) the rationale for varying hues of both tissue and bacterial fluorescence; (4) image artifacts that can occur; and (5) some potentially confounding signals from non-biological materials (e.g., fluorescent cleansing solutions). Therefore, this tutorial provides clinicians with a rationale for identifying common wound fluorescence characteristics. Clinical examples are intended to help clinicians with image interpretation-with a focus on image artifacts and potential confounders of image interpretation-and suggestions of how to overcome such challenges when imaging wounds in clinical practice.

Using Bacterial Fluorescence Imaging and Antimicrobial Stewardship to Guide Wound Management Practices: A Case Series.

The urgent need to eliminate unnecessary use of antibiotics in wound patients has been hampered by diagnostic uncertainty and the time required to obtain culture results. The authors evaluated bedside use of a handheld bacterial fluorescence imaging device for real-time visualization of bacteria within and around wounds, used in addition to monitoring of clinical signs and symptoms of infection, in a series of 7 patients (5 women, 2 men; age range 57-93 years) with varying comorbidities who were referred to the wound ostomy continence clinician for wound assessment. When excited by 405-nm violet light, tissues fluoresce green (collagens) and bacteria fluoresce red; specialized optical filters reveal these colored signals in real time on the device's display screen. Wounds exhibiting red fluorescence were presumed to have moderate/heavy bacterial contamination (≥104 CFU/g) and were subsequently swabbed. Swabs from the 5 wounds with regions of red fluorescence confirmed heavy growth of 1 or more pathogenic bacterial species. Images revealing pronounced bacterial fluorescence in 3 patients with pressure injuries about to be discharged led to prescription of systemic antibiotics and additional patient monitoring. In 2 patients (1 with a skin tear, 1 with a surgical wound), the absence of bacterial fluorescence prevented planned, unwarranted use of systemic antibiotics. Fluorescence images obtained bedside during routine wound assessments had a direct effect on antimicrobial stewardship practices. Follow-up images demonstrated antibiotic effectiveness and, in some instances, led to reduced antibiotic courses and duration. This case series demonstrates the potential use for real-time information on bacterial presence obtained via bacterial fluorescence imaging to guide evidence-based deployment of antibiotics and prevent unnecessary use. Additional studies to optimize the diagnostic potential and randomized controlled studies to examine the effect of this technique on antibiotic usage, antimicrobial stewardship practices, and wound outcomes are warranted.

Correction: It's not the 'what', but the 'how': Exploring the role of debt in natural resource (un)sustainability.

[This corrects the article DOI: 10.1371/journal.pone.0201141.].

It's not the 'what', but the 'how': Exploring the role of debt in natural resource (un)sustainability.

A debt-based economy cannot survive without economic growth. However, if private debt consistently grows faster than GDP, the consequences are financial crises and the current unprecedented level of global debt. This policy dilemma is aggravated by the lack of analyses factoring the impact of debt-growth cycles on the environment. What is really the relationship between debt and natural resource sustainability, and what is the role of debt in decoupling economic growth from natural resource availability? Here we present a conceptual Agent-Based Model (ABM) that integrates an environmental system into an ABM representation of Steve Keen's debt-based economic models. Our model explores the extent to which debt-driven processes, within debt-based economies, enhance the decoupling between economic growth and the availability of natural resources. Interestingly, environmental and economic collapse in our model are not caused by debt growth, or the debt-based nature of the economic system itself (i.e. the 'what'), but rather, these are due to the inappropriate use of debt by private actors (i.e. the 'how'). Firms inappropriately use bank credits for speculative goals-rather than production-oriented ones-and for exponentially increasing rates of technological development. This context creates temporal mismatches between natural resource growth and firms' resource extraction rates, as well as between economic growth and the capacity of the government to effectively implement natural resource conservation policies. This paper discusses the extent to which economic growth and the availability of natural resources can be re-coupled through a more sustainable use of debt, for instance by shifting mainstream banking forces to partially support environmental conservation as well as economic growth.