Search

The aim of this study was to determine the inter-rater reliability between one expert-nurse and four clinical-nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi-experimental design was used to collect the data. In comparison to phase 1 in which 'open questions' were asked, in phase 2 a pre-printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter-rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter-rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect- and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre-printed form than making use of an 'open questions' form. To provide this with a higher level of evidence, there is need for more well conducted studies., (© 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

The aim of this study was to measure the prevalence of (infected) chronic wounds in Dutch nursing homes and to explore which signs and symptoms are used to diagnose infected chronic wounds. Moreover, it was to determine which structural quality indicators related to chronic wound care at ward and institutional levels were fulfilled. In April 2012, as part of the annual National Prevalence Measurement of Care Problems of Maastricht University [Landelijke Prevalentiemeting Zorgproblemen (LPZ)], a multi-center cross-sectional point-prevalence measurement was carried out together with an assessment of relevant care quality indicators. The prevalence was 4·2%; 16 of 72 (22%) chronic wounds were considered to be infected. Increase of exudate (81·3%; n = 13), erythema (68·8%; n = 11), pain (56·3%; n = 9) and wound recalcitrance (56·3%; n = 9) were considered to be diagnostic signs and symptoms of a chronic wound infection. Although at institutional level most quality indicators were fulfilled, at ward level this was not the case. Despite the relatively low number of residents, we consider our population as representative for the nursing home population. It may be an advantage to appoint specific ward nurses and to provide them specifically with knowledge and skills concerning chronic wounds., (© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objective: To perform, from an insurance perspective, a cost analysis of one of the outpatient community wound care clinics in the Netherlands, the Knowledge Centre in Wound Care (KCWC) at Venray., Method: This study involved a cost analysis based on an observational cohort study with a one-year pre-admission and a one-year post-admission comparison of costs. Patients were included when they first consulted the outpatient wound care clinic. Participants were all insured by the same health insurance company, Coöperatie Volksgezondheidszorg (VGZ). A standard six-step procedure for performing cost studies was used to calculate the costs. Given the skewed cost data, non-parametric bootstrapping was used to test for statistical differences., Results: There were 172 patients included in this study. The difference in costs related to wound care between the year before and the year after initial admission to the wound clinic amounted to an average reduction of €2621 (£1873) per patient in the base case analysis. The categories 'general practitioner', 'hospital care', 'mental health care' and 'transport' scored lower, indicating lower costs, in the year after admission to the wound clinic., Conclusion: In this study, only the reimbursement data of patients of one health insurance company, and specifically only those made under the 2006 Dutch Health Insurance Act, were available. Because of the observational design, definitive conclusions cannot be made regarding a demonstrated reduction of costs in the year post admission. Nevertheless, this study is a first attempt of a cost analysis of an equipped outpatient wound clinic as an innovative way of responding to the increasing number of chronic wounds in the Netherlands. The calculations show that savings in wound care are possible., Declaration of Interest: A possible conflict of interest should be mentioned. First author AALM Rondas, PhD student at Maastricht University, is working at the KCWC wound clinic at Venray in the Netherlands as a physician. However, the research data were provided externally by Coöperatie Volksgezondheidszorg (VGZ) and checked by the academic co-authors, none of whom have a conflict of interest. The authors have no financial or commercial interest to declare.

Aim: To determine whether bacteriological analysis of a wound swab is supportive in the clinical assessment of infection of a chronic wound., Methods: Patients attending an outpatient wound clinic who had endured a chronic wound for more than 3 weeks were clinically assessed for infection. In addition, standardized wound swabs were taken according to the Levine technique and the microbiological findings of the swabs compared with the clinical assessment of the wounds., Results: There was no significant relationship between the clinical assessments of the chronic wounds and the qualitative or quantitative bacteriological results of the swabs., Conclusion: Microbiological analysis of wound swabs taken from chronic wounds to support clinical assessment of the wounds is waste of time and money. It may be preferable to assess chronic wounds clinically, however, validation studies of these signs and symptoms are needed.

Objective: The goal of this review was to investigate the usefulness of a wound swab (using the Levine or Z technique) in comparison with a biopsy as a reliable method for the diagnosis of a chronic wound infection., Method: A literature review using the electronic databases PubMed, CINAHL, and MEDLINE were searched by strategy. A total of 6 articles fulfilled the inclusion criteria., Main Results: The Levine technique detects more organisms in acute wounds, as well as in chronic wounds, than the Z technique. Comparing both with the biopsy as criterion standard, the diagnostic accuracy to diagnose a chronic wound infection by the Levine technique was higher in comparison to the Z technique. At a threshold of 3.7 × 10(4) microorganisms per swab, the Levine technique had a sensitivity of 0.90, a specificity of 57%, and a positive predictive value and negative predictive value of 0.77 and 0.91, respectively. Description of the method of swab taking was diverse and not uniform., Discussion: Only a few studies in the literature compare wound swabs with biopsies for the diagnosis of chronic infected wounds. Until now, the Levine technique has been considered as the most reliable and valid method, but there is an urgent need for a well-designed study with a sufficient number of patients to optimize the diagnostic accuracy of chronic infected wounds., Conclusion: The best sampling technique for taking a swab has not yet been identified and validated. Until then, the authors recommend the Levine technique.

This study investigated the number and type of chronic wounds actually treated by Dutch nursing home physicians (NHPs). It was also the goal to know how many of the treated chronic wounds they considered infected. The NHPs were asked to choose and rank their top five out of several provided criteria for chronic wound infection. After this, the ranking was compared with the choices an international multidisciplinary Delphi group of wound experts made in 2005. A cross-sectional descriptive survey was conducted using the information from a self-reported questionnaire in a representative sample of Dutch NHPs. About 361 NHPs (25%) were sent a questionnaire. Of the 361 physicians, 139 (38.5%) filled in and returned the questionnaire of which 121 were valid. Of the NHPs, 73.5% actually treated at least one chronic pressure ulcers (PU), whereas 26.5% did not treat any. Of the responding NHPs,31.6 % treated at least one, but never more than two chronic post surgical wounds , whereas 68.4% of the NHPs treated none [corrected]. Chronic venous leg ulcers, arterial ulcers and diabetic ulcers scored infrequently and less than the other two sorts of chronic wounds. Of the Dutch NHPs, 53% considered that none of the PU infected. The other chronic wounds were judged far less frequently to be infected. Dutch NHPs appeared to use more 'traditional' criteria such as 'puss/abscess' and 'malodour' to identify infection and did not change their criteria by wound type. According to this study, NHPs do not frequently see many chronic wounds. The most frequent type of wounds treated was PU. For NHPs, the identification of infection of all types of chronic wounds is difficult. The use of criteria that is not in line with consensus documents may lead to ineffective treatment and even seriously damage patients: the clinical identification of infection is still dependent on experts' opinion. Further research on triggers for the suspicion of wound infection and the development of an evidence-based guideline is necessary.

Objective: To collect medical-ethical arguments for and against the practice of terminal sedation in mentally-competent patients., Design: Literature search., Method: Medical-ethical arguments for and against the practice of terminal sedation were sought in electronic databases, for example Pubmed, Medline, and the Netherlands Institute for Scientific Information Services. The arguments found can help in making a well-considered and careful decision., Results: Terminal sedation can be defined as deliberately inducing and maintaining deep sleep in terminally-ill patients with recalcitrant symptoms, by using high doses of sedatives but without the intention of hastening death. Arguments in favour of this approach included: good care provision, useful medical procedure, autonomy of the patient, the doctrine of the double effect and an alternative for euthanasia and assisted suicide. Arguments against included: impossible to communicate due to sedation, responsibility for unintended consequences, shortening the length of life, religious and cultural objections, incompetence, abuse by the care-provider or the patient and the interest of the physician., Conclusion: In the literature no overriding moral objections to the use of terminal sedation were found. This palliative option may be regarded as a useful addition to the existing range of interventions. Although it can never be excluded, abuse is not a decisive factor. There seems to be a need for a guideline with meticulous criteria and procedures that promotes the responsible use of this intervention.

This article describes the clinical history of a woman aged 75 with a pseudolymphoma syndrome that was probably a consequence of the use of carbamazepine. This syndrome is characterised by lymphadenopathy, fever and a generalised rash. These signs can easily be confused with the existence of a true malignant T-cell lymphoma or Hodgkin's disease. Chemotherapy may be given to these patients if this adverse reaction, which mimicks a true malignant lymphoma, is not recognised. After withdrawal of the drug the symptoms disappear mostly in a few days.

The cholinergic receptors in rabbit isolated rectus muscle preparations were characterized by means of cholinergic agonists and antagonists. The concentration-dependent contraction induced by acetylcholine, carbachol or oxotremorine remained uninfluenced by atropine (10(-5) M), whereas the nicotinic receptor antagonist hexamethonium caused a parallel shift of the concentration-response curve. The agonists pilocarpine, methacholine and aceclidine, which are selective muscarinic receptor stimulants, did not cause contraction of the muscle preparation. However, the nicotinic receptor stimulant 1,1-dimethyl-4-phenylpiperazine iodide (DMPP) caused contraction similar to that induced by acetylcholine. DMPP-induced contractions were inhibited by hexamethonium, causing a parallel rightward shift of the concentration-response curve. This shift could be quantified by means of a Schild plot, indicating competitive antagonism with a PA2 value of 4.63 for hexamethonium. Atropine when applied together with hexamethonium did not cause a further shift of the concentration-response curve. The present results clearly indicate that the cholinergic receptors which mediate contraction in the rabbit isolated extraocular muscle preparation belong to the nicotinic subtype.