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Background: Diabetic foot ulceration (DFU) has become an increasingly common emergency presentation. These patients are presenting at a younger age and with increasingly complex co-morbidities. They require frequent hospitalisation for management of DFU which has significant consequences for management of health resources but also for quality of life in the diabetic patient population., Aim: The aim of this study was to evaluate the impact of the development of a coordinated, streamlined acute diabetic foot pathway for management of in-patients presenting as emergencies with DFU on length of stay, re-admission to hospital and minor and major amputations., Methods: A dedicated acute diabetic foot pathway was introduced to St. Vincent's University Hospital (SVUH) in April 2016. Management of patients admitted urgently to the emergency department or out-patient clinics of St. Vincent's University Hospital during the 3-year period before April 2016 was compared to that of patients admitted in the 3 years after April 2016 following introduction of the acute diabetic foot pathway. Demographic data hospital length of stay, need for re-admission, major and minor amputations performed and cost of hospital stay were compared before and after introduction of the pathway., Results: There were 931 admissions with acute diabetic foot ulceration or infection between January 2012 and December 2019; 419 were admitted between January 2012 and March 2016 and 512 between April 2016 and December 2019. There was no difference in demographic data between the two time periods. Length of stay decreased from 13 +/- 4.24 to 3 +/- 1.41 days between the two time periods (p < 0.001). Re-admission rates within 30 days decreased from 21.7 to 10.1% (p < 0.05). The number of major lower limb amputations decreased over the two time periods from 8.8 to 7.2% with a concomitant increase in minor amputations from 16.7 to 25.3%. Risk of major lower limb amputation was significantly higher in those patients living more than 20 km from the hospital. Costs associated with in-patient stay for management of DFU decreased from €9,247,700 to €8,988,100 despite an 18% increase in the number of patients treated and a 9.9% increase in hospital admissions., Conclusion: Introduction of a dedicated, streamlined pathway involving multi-disciplinary input resulted in a significant improvement in patient management as assessed by length of hospital stay and need for re-admission. While the number of major lower limb amputations has decreased there has been a significant increase in the number of minor amputations., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Concerns have arisen internationally over the competency of student nurses to perform wound care. A global shortage of nursing faculty and clinical practice opportunities is regarded as a contributing factor. Virtual simulation offers a possible solution. The aim of this study was to describe the development and educational evaluation of a virtual patient to supplement undergraduate learning of wound care. The National League for Nursing Jeffries model informed the design of the media. Evaluation of the virtual patient by penultimate year nursing students (n = 148) was conducted using a survey design. Findings are presented from statistical and directed content analyses. Most students rated the educational value of the virtual patient and its support of learning highly. They reported a perceived increase in confidence and ability to meet wound care competency outcomes. The virtual patient also provided students with opportunities to develop their clinical reasoning skills. This study provides evidence that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care. It allows nursing students the opportunity to practice skills and utilise theory repetitively in a safe environment, unhampered by a lack of resources such as clinical placement availability and a declining faculty., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Both nationally and internationally concerns have been expressed over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. This project describes the educational evaluation of a series of Reusable Learning Objects (RLOs) as a blended learning approach to facilitate undergraduate nursing students learning of wound care for competence development. Constructivism Learning Theory and Cognitive Theory of Multimedia Learning informed the design of the RLOs, promoting active learner approaches. Clinically based case studies and visual data from two large university teaching hospitals provided the authentic learning materials required. Interactive exercises and formative feedback were incorporated into the educational resource., Methods: Evaluation of student perceived learning gains in terms of knowledge, ability and attitudes were measured using a quantitative pre and posttest Wound Care Competency Outcomes Questionnaire. The RLO CETL Questionnaire was used to identify perceived learning enablers. Statistical and deductive thematic analyses inform the findings., Results: Students (n=192) reported that their ability to meet the competency outcomes for wound care had increased significantly after engaging with the RLOs. Students rated the RLOs highly across all categories of perceived usefulness, impact, access and integration., Conclusion: These findings provide evidence that the use of RLOs for both knowledge-based and performance-based learning is effective. RLOs when designed using clinically real case scenarios reflect the true complexities of wound care and offer innovative interventions in nursing curricula., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aims and Objectives: The aim of this project was to develop an educational package for undergraduate student nurses that would provide them with the theoretical knowledge and clinical judgement skills to care for a patient with a wound., Background: Internationally there is concern over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. Deficits have also been identified in the underpinning biological sciences needed for this skill. Expectations associated with wound management have altered significantly in the last two decades with decision making around wound care coming under the scope of practice of nurses. The treatment and care options for patients with wounds must be based on a sound knowledge of how wounds are formed and healed. If nurses do not have the evidence-based knowledge, it can affect wound healing adversely leading to increased patient suffering, pain and delayed healing. From an organisational perspective, delayed healing will increase the cost of care., Design: This project used constructivism learning theory to provide a framework for the development of a wound care educational package for undergraduate Irish nurses in their penultimate year of training., Methods: Collaboration was formed with key stake holders. Pertinent curriculum content was mapped. Learning strategies to suit the incoming student learning styles were incorporated into newly developed theoretical content and practical skill sessions., Conclusion: The developed educational programme will assist student nurses in their care of patients with wounds., Relevance to Clinical Practice: This study provides a model that can be followed to develop small units of the study to keep abreast of changes in health care delivery and the changing scope of practice of nurses. It also contributes to the debate on the teaching and learning of biosciences as it highlights the depth of biological knowledge required as a basis for good evidence-based nursing care., (© 2015 John Wiley & Sons Ltd.)

Toxic aldehydes produced by alcohol dehydrogenases have been implicated in the pathogenesis of Helicobacter pylori-related damage to the gastric mucosa. Despite this, the enzymes that might be responsible for producing such aldehydes have not been fully described. It was, therefore, of considerable interest to characterize the alcohol oxidizing enzymes in this pathogen. Previous work in this laboratory characterized two such H. pylori enzymes that had broad specificity for a range of aromatic alcohol substrates. However, an enzyme with specificity for aliphatic alcohols is likely to be required in order that H. pylori can metabolize the wide range of substrates encountered in the gastric mucosa. In this study we describe HpSCADH, an alcohol dehydrogenase from H. pylori 26695 with broad specificity for aliphatic alcohols. HpSCADH was classified in the cD1e subfamily of classical short chain alcohol dehydrogenases. The enzyme was a monomer of approximately 29kDa with a preference for NAD(+) as cofactor. Pyrazole was found to be a competitive inhibitor of HpSCADH. The physiological role of this enzyme was explored by construction of an HpSCADH isogenic mutant. At pH 7.0 the mutant showed reduced growth which became more pronounced when the pH was lowered to 5.0. When pyrazole was added to wild type H. pylori cells it caused growth profiles to be reduced to match those of the isogenic mutant suggesting that HpSCADH inhibition alone was responsible for growth impairment. Taken together, the data relating to the alcohol metabolizing enzymes of this pathogen indicate that they play an important role in H. pylori growth and adaptation to acidic environments. The therapeutic potential of targeting H. pylori alcohol dehydrogenases is discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Pyridine-linked oxidoreductase enzymes of Helicobacter pylori have been implicated in the pathogenesis of gastric disease. Previous studies in this laboratory examined a cinnamyl alcohol dehydrogenase that was capable of detoxifying a range of aromatic aldehydes. In the present work, we have extended these studies to identify and characterize an aldoketo reductase (AKR) enzyme present in H. pylori. The gene encoding this AKR was identified in the sequenced strain of H. pylori, 26695. The gene, referred to as HpAKR, was cloned and expressed in Escherichia coli as a His-tag fusion protein, and purified using nickel chelate chromatography. The gene product (HpAKR) has been assigned to the AKR13C1 family, although it differs in specificity from the two other known members of this family. The enzyme is a monomer with a molecular mass of approximately 39 kDa on SDS/PAGE. It reduces a range of aromatic aldehyde substrates with high catalytic efficiency, and exhibits dual cofactor specificity for both NADPH and NADH. HpAKR can function over a broad pH range (pH 4-9), and has a pH optimum of 5.5. It is inhibited by sodium valproate. Its substrate specificity complements that of the cinnamyl alcohol dehydrogenase activity in H. pylori, giving the organism the capacity to reduce a wide range of aldehydes. Generation of an HpAKR isogenic mutant of H. pylori demonstrated that HpAKR is required for growth under acidic conditions, suggesting an important role for this enzyme in adaptation to growth in the gastric mucosa. This AKR is a member of a hitherto little-studied class.