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The care and management of surgical incisional wounds continues to attract both interest and concern, due to continued high rates of surgical site infection (SSI) and morbidity. Novel approaches to objective wound assessment using noninvasive imaging modalities show promise in providing independent, objective wound assessment but only with the proviso that the wound is visible and can be 'seen' by the imaging detector. Methods: An online semi-structured questionnaire was distributed via Survey Monkey to tissue viability nurses. Data was summarised descriptively, with responses relating to participant demographics and use of wound dressings tabulated. Key variables were also cross tabulated to investigate possible associations between variables. An economic analysis was conducted to estimate average weekly costs associated with changing and applying dressings, including both staff and equipment costs. Conclusion: The largest type of dressing products currently in use were nonadherent. Dressing changes took place approximately twice per week: more frequently if wounds were assessed/diagnosed as infected. The majority of wound assessment and dressing changes were undertaken by band 5, 6 or 7 nurses. There is a potential role for non-invasive infrared thermography to stratify risk of later SSI based upon the temperature distribution across wound site and adjacent skin territories. Early and objective interventions for early wound infection can reduce hospital inpatient stay, community visits, antimicrobial usage, patient morbidity and healthcare costs related to wound infection. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is associated with biochemical evidence of low-grade inflammation, and experimental studies have suggested that both insulin and glucose affect inflammatory responses. To determine the effect of in vivo changes in glucose availability and plasma insulin concentrations in humans, we administered 20 U/kg Escherichia coli lipopolysaccharide (LPS) or saline (control) to 14 subjects during a euglycemic hyperinsulinemic clamp (n = 6) or an infusion of sterile saline (n = 8). Parallel in vitro studies on human whole blood were undertaken to determine whether there was a direct effect of glucose, insulin, and leptin on proinflammatory cytokine production. Infusion of glucose and insulin significantly amplified and/or prolonged the cardiovascular, plasma interleukin-6 (IL-6), tumor necrosis factor-[alpha] (TNF-[alpha]), and counterregulatory hormone responses to LPS, whereas the effects on fever, plasma norepinephrine concentrations, and oxygen consumption were unaffected. In vitro studies showed no modulation of LPS-stimulated IL-6 or TNF-[alpha] production by glucose, insulin, or leptin at physiologically relevant concentrations. Hyperinsulinemia indirectly enhances key components of the systemic inflammatory and stress responses in this human model of infection. diabetes; cytokines; lipopolysaccharide; inflammation; sepsis

Abstract Background The purpose of Abbreviated Injury Scale (AIS) is to code various types of Traumatic Brain Injuries (TBI) based on their anatomical location and severity. The Marshall CT Classification is used to identify those subgroups of brain injured patients at higher risk of deterioration or mortality. The purpose of this study is to determine whether and how AIS coding can be translated to the Marshall Classification Methods Initially, a Marshall Class was allocated to each AIS code through cross-tabulation. This was agreed upon through several discussion meetings with experts from both fields (clinicians and AIS coders). Furthermore, in order to make this translation possible, some necessary assumptions with regards to coding and classification of mass lesions and brain swelling were essential which were all approved and made explicit. Results The proposed method involves two stages: firstly to determine all possible Marshall Classes which a given patient can attract based on allocated AIS codes; via cross-tabulation and secondly to assign one Marshall Class to each patient through an algorithm. Conclusion This method can be easily programmed in computer softwares and it would enable future important TBI research programs using trauma registry data.