Silver-containing foam dressings with Safetac: a review of the scientific and clinical data.

Background Topical antimicrobials, such as silver dressings, are progressively being used alongside systemic antibiotics to provide adjunctive, antimicrobial therapy to wounds that are clinically infected or at risk of infection. To help improve wound management, dressings that use Safetac soft silicone technology in combination with a silver-impregnated foam dressing material were developed by Mölnlycke Health Care (Gothenburg, Sweden). The range comprises Mepilex Ag, Mepilex Border Ag and Mepilex Transfer Ag. Aims A literature review was undertaken to identify and summarise clinical data from the entire evidence hierarchy, as well as data from in vitro tests, which support the use of silver-containing foam dressings with Safetac. Method The MEDLINE (National Library of Medicine, Bethesda, US) and EMBASE (Elsevier BV, Amsterdam, Netherlands) bibliographic databases were searched. In addition, abstract books and proceedings documents relating to national and international conferences were scanned in order to identify presentations (oral, e-poster and poster) of relevance to the review. Results In vitro test results showed that the silver-containing foam dressings with Safetac have both rapid and sustained activity against a range of wound pathogens, reducing planktonic and established biofilm cultures, and preventing biofilm formation. In numerous clinical studies, silvercontaining foam dressings with Safetac were used to manage wound bioburden effectively and resolve signs of localised infection in both acute wounds (such as surgical, traumatic and burn injuries) and chronic wounds (such as leg ulcers, pressure ulcers (PUs), diabetic foot ulcers (DFUs), and cancerous wounds). Studies reported that silver-containing foam dressings with Safetac are easy to use, provide an optimal environment for wound healing, and are associated with atraumatic and virtually painfree removal. As well as being clinically effective, they are reported to be cost-effective when used on wounds that require topical antimicrobial therapy. Conclusion The findings of both scientific and clinical studies clearly indicate that clinical, patient-related and economic benefits are associated with the use of Mepilex Ag, Mepilex Border Ag and Mepilex Transfer Ag with Safetac in the treatment of wounds where antimicrobial activity is needed to help manage bioburden.

Role of multi-layer foam dressings with Safetac in the prevention of pressure ulcers: a review of the clinical and scientific data.

BACKGROUND: Despite the implementation of prevention strategies, pressure ulcers (PUs) continue to be a challenging health problem for patients (and their carers), clinicians and health-care providers. One area of growing interest is the use of prophylactic dressings (which were originally designed for the treatment of PUs and other wound types) as a component of standard prevention measures. Over the past few years, a large amount of scientific and clinical data relating to this subject has been published in peer-reviewed journals and presented at international meetings and conferences. A substantial proportion of these data relate to one group of dressings: multi-layer foam dressings with Safetac, which are manufactured by Mölnlycke Health Care (Gothenburg, Sweden). This evidence pool has influenced the experts involved in updating the Clinical Practice Guideline, produced by the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, on the prevention and treatment of PUs. The updated Guideline, published in 2014, recommends that, as part of their PU prevention regimens, clinicians should consider applying prophylactic dressings to bony prominences in anatomical areas that are frequently subjected to friction and shear. AIMS: A literature review was undertaken to identify clinical data from the entire evidence hierarchy, as well as scientific data from laboratory studies, on the use of multi-layer foam dressings with Safetac in the prevention of pressure ulceration. METHOD: The MEDLINE (National Library of Medicine, Bethesda, US) and EMBASE (Elsevier B, Amsterdam, Netherlands) bibliographic databases were searched. In addition, abstract books and proceedings documents relating to national and international conferences were scanned in order to identify presentations (i.e. oral, e-posters and posters) of relevance to the review. RESULTS: Clinical and health economic experts have undertaken numerous studies, including randomised controlled trials, to assess the efficacy and cost-effectiveness of using multi-layer foam dressings with Safetac as a component of standard PU prevention strategies. The results of these studies indicate that the application of multi-layer foam dressings containing Safetac can reduce the occurrence of PUs on anatomical locations such as the sacrum and the heel, and underneath medical devices. Scientists have also developed and used laboratory methods to gain a better understanding of how prophylactic dressings work. The results of these studies indicate that the composition of foam dressings containing Safetac (i.e. their multi-layer structure) sets them apart from other dressings due to their ability to mediate the effects of physical forces (i.e. pressure, friction and shear) and control microclimate, all of which contribute to pressure ulceration. CONCLUSION: The evidence pool clearly indicates that the prophylactic use of multi-layer foam dressings with Safetac as a component of standard prevention measures is beneficial to the clinician, the health-care provider and the patient. It should be noted that the findings outlined in this review may not be transferable to other products as their makeup and components are likely to differ significantly from those of multi-layer foam dressings with Safetac. As the importance of evidence-based practice and the need for cost-effective care continues to grow, clinicians and provider should carefully consider this point when selecting prophylactic dressings for PU prevention.

Machine Learning in Colorectal Cancer Risk Prediction from Routinely Collected Data: A Review.

The inclusion of machine-learning-derived models in systematic reviews of risk prediction models for colorectal cancer is rare. Whilst such reviews have highlighted methodological issues and limited performance of the models included, it is unclear why machine-learning-derived models are absent and whether such models suffer similar methodological problems. This scoping review aims to identify machine-learning models, assess their methodology, and compare their performance with that found in previous reviews. A literature search of four databases was performed for colorectal cancer prediction and prognosis model publications that included at least one machine-learning model. A total of 14 publications were identified for inclusion in the scoping review. Data was extracted using an adapted CHARM checklist against which the models were benchmarked. The review found similar methodological problems with machine-learning models to that observed in systematic reviews for non-machine-learning models, although model performance was better. The inclusion of machine-learning models in systematic reviews is required, as they offer improved performance despite similar methodological omissions; however, to achieve this the methodological issues that affect many prediction models need to be addressed.

Australian gridded chloride deposition-rate dataset.

Chloride deposition-rate measurements at points within Australia are upscaled to the entire continent on a regular 0.05° grid. The upscaling uses a double-exponential correlation between deposition rate and distance to the coast, where the parameters in the double-exponential are spatially varying. These parameters are estimated using least-squares with Tikhonov regularisation to ensure minimal spatial variability. A calibration-constrained, null-space Monte-Carlo analysis is used to quantify uncertainty in the prediction. The resulting dataset consists of the best-fit chloride deposition rates across Australia, as well as estimates of uncertainty. The dataset can be used for various purposes including: estimating groundwater recharge through the use of the chloride mass-balance method; catchment salt balance estimates; regional investigations of groundwater hydrochemistry; and, corrosion prediction.

Contributors to negative biopsychosocial health or performance outcomes in rugby players (CoNBO): a systematic review and Delphi study protocol.

The importance of contributors that can result in negative player outcomes in sport and the feasibility and barriers to modifying these to optimise player health and well-being have yet to be established. Within rugby codes (rugby league, rugby union and rugby sevens), within male and female cohorts across playing levels (full-time senior, part-time senior, age grade), this project aims to develop a consensus on contributors to negative biopsychosocial outcomes in rugby players (known as the CoNBO study) and establish stakeholder perceived importance of the identified contributors and barriers to their management. This project will consist of three parts; part 1: a systematic review, part 2: a three-round expert Delphi study and part 3: stakeholder rating of feasibility and barriers to management. Within part 1, systematic searches of electronic databases (PubMed, Scopus, MEDLINE, SPORTDiscus, CINAHL) will be performed. The systematic review protocol is registered with PROSPERO. Studies will be searched to identify physical, psychological and/or social factors resulting in negative player outcomes in rugby. Part 2 will consist of a three-round expert Delphi consensus study to establish additional physical, psychological and/or social factors that result in negative player outcomes in rugby and their importance. In part 3, stakeholders (eg, coaches, chief executive officers and players) will provide perceptions of the feasibility and barriers to modifying the identified factors within their setting. On completion, several manuscripts will be submitted for publication in peer-reviewed journals. The findings of this project have worldwide relevance for stakeholders in the rugby codes. PROSPERO registration number CRD42022346751.

Trends in player body mass at men's and women's Rugby World Cups: a plateau in body mass and differences in emerging rugby nations.

OBJECTIVES: This study assessed the mass of international rugby players in the men's and women's Rugby World Cups between 1991 and 2019. The objective was to quantify changes in mass of players by position, and to compare changes between men and women, and between established (Tier 1 (T1)) and emerging (Tier 2 (T2)) rugby nations. SETTING: Rugby World Cups from 1991 to 2019 for men's players and 2010 to 2017 for women's players. PARTICIPANTS: 4447 elite male and 958 elite female players. PRIMARY AND SECONDARY OUTCOME MEASURES: Player body mass, grouped as men and women, T1 and T2 nations, and by playing position, assessed over time. RESULTS: Men's player mass increased significantly between 1991 and 2019 (T1 overall 9.7% increase), but this increase occurred almost entirely up to 2011. Women's forwards mass increased by 4.8% in T1, with no changes in T2 or backs from either tier. Significant differences in mass were found between T1 and T2 forwards and backs for both men and women. CONCLUSIONS: The body mass of men's players has stabilised after initial increases following professionalisation. Player body mass may be approaching a plateau, beyond which no further performance advantages occur. Changes to laws and tactical approaches by coaches may have contributed to this, by changing match demands on players, necessitating endurance, agility and speed. Trends in the evolution of T2 players suggest a barrier to identifying and developing heavy athletic players, and may require intervention to ensure competitive parity.

Influence of thermal treatment on nanostructured gold model catalysts.

We fabricated films of Au onto single crystal alumina (Al(2)O(3)(0001)) and nanostructured the surface using a high resolution focused ion beam (FIB) to remove specific regions of the film. The nanostructures consist of lines and orthogonal lines cut into the film, resulting in one- and two-dimensional islands of gold. When these films are heated above 300 °C, small nanoparticles of gold form due to the dewetting of the Au film from the alumina surface. The dimensions of these islands are dictated by the nature of the nanopatterning. The isolated islands generally have the smallest nanoparticles after heating, while the unpatterned film has much larger particles. Sintering is reduced within the nanostructured metal domains due to isolation of Au islands from each other. The evaporation rate is higher within these islands, due to the smaller size of nanoparticles and hence the higher effective vapor pressure over the surface (the Kelvin effect).

Evidence Synthesis International (ESI): Position Statement.

This paper is the initial Position Statement of Evidence Synthesis International, a new partnership of organizations that produce, support and use evidence synthesis around the world. The paper (i) argues for the importance of synthesis as a research exercise to clarify what is known from research evidence to inform policy, practice and personal decision making; (ii) discusses core issues for research synthesis such as the role of research evidence in decision making, the role of perspectives, participation and democracy in research and synthesis as a core component of evidence ecosystems; (iii) argues for 9 core principles for ESI on the nature and role of research synthesis; and (iv) lists the 5 main goals of ESI as a coordinating partnership for promoting and enabling the production and use of research synthesis.

Evidence review: the clinical benefits of Safetac technology in wound care.

Common causes of trauma and wound pain include: the removal of dressings that become stuck to the wound bed; skin stripping of peri-wound skin, as a result of the repeated application and removal of adhesive dressings; and tissue excoriation and maceration of the peri-wound skin, due to inadequate management of wound exudate. This supplement outlines how dressings with Safetac adhesive technology can help clinicians to avoid these problems. A review of the clinical and scientific evidence relating to dressings with Safetac clearly demonstrates that they can be used to prevent trauma and minimise pain on a wide range of wound types and skin injuries.

Case of the month: "Oh! Drat!--A case of transcutaneous superwarfarin poisoning and its recurrent presentation".

Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. The National Poisons Information Service is presently auditing cases. The case of a farmer who presented with haematuria, 9 days after spilling a rodenticide containing a superwarfarin over himself is reported here. He was physically well except for mild abdominal tenderness. He had grossly deranged clotting studies (prothrombin time (PT) >200 s, activated partial thromboplastin time (APTT) 56 s) that were rapidly corrected with fresh frozen plasma and vitamin K. He was sent home after 5 days without follow up. Unfortunately, he presented again 2 days later, again with haematuria and an international normalised ratio (INR) >10. He required inpatient treatment with high-dose vitamin K for 1 week. Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.

Workshop Report: Aerosol Delivery to Spontaneously Breathing Tracheostomized Patients.

The number of pediatric and adult patients requiring tracheostomy has increased. Many of them require aerosol therapy as part of their treatment. Practitioners have little guidance on how to optimize drug delivery in this population. The following is a report of a workshop dedicated to review the current status of aerosol delivery to spontaneously breathing tracheostomized patients and to provide practice recommendations.

What is happening to the patient during pre-hospital trauma care?

We report a PDA based in-flight (pre-hospital) patient vital signs data recorder (VSDR) system which captures both numerical and continuous waveforms from a patient monitor in real-time. Nine pre-hospital Life-Saving-Intervention (LSI) event markers were configured for rapid real-time event documentation. A VSDR data set from first field encounter through hospital arrival could be wirelessly downloaded to a secure server and displayed on the VSDR-Viewer. Preliminary in-flight patient runs demonstrated the VSDR concept and future potential.