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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
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The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on in vivo use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl's biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of in vivo applications in the context of the body's own physiological defense mechanisms.
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Background: This qualitative exploratory research was the first study to explore Leg Club volunteering through focusing specifically on volunteers' narratives. Aim(s): The aim was to understand volunteers' motivations and experiences and to outline the crucial steps for maintaining volunteers' positive trajectory towards providing social support. Method(s): A qualitative study based on semi-structured interviews with volunteers from UK Leg Clubs was undertaken. Interview transcripts were analysed using a constructivist reflexive thematic analysis. Result(s): I recruited 16 volunteers from three UK Leg Clubs. The study explained the motivations for volunteering (started as members or companions;retired individuals with a strong sense of purpose;emotional, social and mental health reasons), experiences of volunteering (satisfaction from helping;meaningful social connections;personal growth) and volunteers' objectives (desire to recruit more volunteers;concerns about long-term capacity to return to pre-pandemic activities). Conclusion(s): The study outlines the conditions necessary for Leg Club volunteers' continued success in the social dimension of leg care. Declaration of Interest: Dr Anna Galazka is a volunteer project consultant for the Lindsay Leg Club Foundation. The research was funded by Cardiff Business School Research and Scholarship Seedcorn Funding Scheme.Copyright © 2023, OmniaMed Communications Ltd. All rights reserved.
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Facial palsy (FP) is a life changing condition with physical, aesthetic, functional and psychosocial consequences, which requires specialized diagnosis, rehabilitation and (surgical) management to improve facial function and reduce its negative effects. Since patients remain in follow-up during their life and often have to travel far to receive treatment, improvements can be made in the field of telemedicine. Telemedicine is a growing field of study in medical practice and several advances have been made in the field of plastic surgery. Especially during the COVID-19 pandemic, considerable experience was gained in this way of consultation. This review provides an overview of current research available in the field of E-Health and M-Health in plastic surgery and for patients with a peripheral facial palsy.Copyright © 2021 The Author(s)
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COVID-19 has highlighted a brutal reality known for decades, that Black, Indigenous, and People of Color bear a disproportionate burden of US annual sepsis cases. While plentiful research funds have been spent investigating genetic reasons for racial disparities in sepsis, an abundance of research shows that sepsis incidence and mortality maps to indicators of colonial practices including residential segregation, economic and marginalization sepsis, and denial of care. Here we argue that sepsis risk is an immunological embodiment of racism in colonial states, that the factors contributing to sepsis disparities are insidious and systemic. We show that regardless of causative pathogen, or host ancestry, racialized people get and die of sepsis most frequently in a pattern repeatedly reiterated worldwide. Lastly, we argue that while alleviation of sepsis disparities requires radical, multiscale intervention, biological anthropologists have a responsibility in this crisis. While some of us can harness our expertise to take on the ground action in sepsis prevention, all of us can leverage our positions as the first point of contact for in depth human biology instruction on most college campuses. As a leading cause of death worldwide, and a syndrome that exhibits the interplay between human physiology, race and environment, sepsis is at the nexus of major themes in biological anthropology and is a natural fit for the field's curriculum. In adopting a discussion of race and sepsis in our courses, we not only develop new research areas but increase public awareness of both sepsis and the factors contributing to uneven sepsis burden.Copyright © 2022 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.
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In the face of massive numbers of casualties returning to the UK in World War 1, health services were rapidly reorganized under the leadership of Sir Alfred Keogh. Hundreds of military hospitals were set up. Sir Alfred personally asked two women doctors, both militant suffragettes and members of the British Women's Social and Political Union, to set up and run a hospital in London. This remarkable hospital was to pioneer new antiseptic treatments for wounds. Endell Street Military Hospital was set up in 1915 by doctors Flora Murray and Louisa Garrett Anderson. The hospital was staffed and run solely by women, treating 26 000 patients in 520 beds over the course of the war. One of their most heroic contributions was to the care of wounds in injured soldiers returning from France. Throughout the war wound infections led to the deaths of thousands of soldiers and contributed to significant morbidity such as limb loss in countless others. In 1916 James Rutherford Morrison, Professor of Surgery in Durham, invented bismuth iodoform paste (BIPP) for the treatment of wound infections. The paste has significant antimicrobial properties. The Endell Street doctors contacted Morrison in June 1916 and started using his formulation on injured patients. By early 1917 they had treated > 400 patients with gunshot wounds, compound fractures, septic wounds, through-and-through wounds and foreign body wounds with BIPP, reporting their findings in The Lancet (Garrett Anderson L, Chambers H. The treatment of septic wounds with bismuth-iodoform-paraffin paste. Lancet 1917;189: 331-3). They reported no cases of tetanus or gas gangrene and were able to explain side-effects such as iodine and bismuth poisoning, why it occurred and how it could be avoided. BIPP has been in use constantly since 1916, and is still used today in ear, nose and throat departments, especially for packing nasal cavities. By changing from the traditional eusol (sodium hypochlorite solution) to BIPP Drs Murray and Anderson reduced dressing changes from daily to once every 7-14 days, saving staff time, costs and hugely improving outcomes. These women doctors saved hundreds of lives and pioneered wound treatments that are still used today. Both were awarded the CBE for their services, but sadly the hospital staff were sacked at the end of the war, when the hospital closed. This form of pioneering work, conducted under great strain with limited resources is still to be seen today in the COVID-19 pandemic.
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Historically, information such as protocols and treatment pathways from specialist teams were shared with ward staff in paper format which proved cumbersome and difficult to update. Improvements were made with the addition of an intranet site, where protocols could be stored and accessed by clinical staff, however it was recognised that navigating the intranet site was not always straightforward and took up precious nursing time. The tissue viability team at the Royal United Hospitals NHS Foundation Trust (RUH) considered how such information might be made more readily available to clinicians. Inspired by widespread increased use of QR codes in public places during the COVID-19 pandemic, the team produced a poster containing multiple QR codes, enabling clinical staff to have instant access to wound care protocols as soon as the information was needed.Copyright © 2023, OmniaMed Communications Ltd. All rights reserved.
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OBJECTIVE: To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD: A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS: In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION: PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
Subject(s)
COVID-19 , Pressure Ulcer , Humans , COVID-19/epidemiology , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Critical Care , Delivery of Health Care , PrevalenceABSTRACT
OBJECTIVE: The burden of chronic wounds did not disappear during the Covid-19 pandemic, so new ways to address healthcare practitioner (HCP) education had to evolve. The Teach, Try, and Talk (T3) programme was conceived in 2021 with HCPs in southern Europe (Italy, Spain and Portugal). METHOD: Virtual education sessions with experienced HCP guest speakers were held and a five-layer hydrocellular polyurethane foam dressing (HPFD) was introduced as a way of reducing dressing change frequencies and improving clinician satisfaction. HCPs recorded their experience of the HPFD using an online form and participated in a further virtual session with experienced HCPs to discuss the results. RESULTS: There were a total of 190 responses. A significant dressing change reduction from 3.6 changes per week to 1.8 with the HPFD (p<0.001) was observed in Italy, Spain and Portugal and within different care settings (hospital, wound clinic/health centre and the patient's home). Nearly one-third of participants stated one more day of dressing wear time was achieved by the ability of the HPFD to lock in and manage exudate, with nearly a quarter of responses stating it was due to fewer than three dressing lobes being full. The majority (97.8%) of HCPs stated they would recommend the HPFD to colleagues and patients. CONCLUSION: The T3 programme is a highly successful method of training delivery and practice improvement across a variety of healthcare settings in southern Europe, helping support HCP engagement and ongoing development in challenging times during the Covid-19 pandemic. The programme can be adapted considering the needs of different HCPs and payor and/or healthcare systems.
Subject(s)
COVID-19 , Pandemics , Humans , Wound Healing , COVID-19/epidemiology , Bandages , Surgical Wound Infection , EuropeABSTRACT
Objectives: To evaluate the usability and effectiveness of a digital application for wound care from a clinician-and-patient user perspective. Methods: A quasi-experimental design was conducted in four settings in an Australian health service from July to December 2019 to October 2020. Owing to the coronavirus disease pandemic, the study paused in March 2020 but then restarted immediately after 3 weeks. Data were collected from patients in the standard group (n = 166, 243 wounds), and intervention group (n = 124, 184 wounds). Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively. Interviews were thematically analysed. Results: Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. Compared to the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% versus 70%, p < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99 %). The travel-related fuel cost saved for a patient living in a rural area was on average $72.90. Conclusions: The digital application provided real-time wound data with an interface for communication between the patient and clinician and clinicians in a hospital, community, and outpatient setting in a variety of settings. The use of the application facilitated remote patient monitoring, and reduced patient travel time, while maintaining optimal wound care.
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A mobile application for wound care (Minuteful) was trailed over a seven-month period in an acute inpatient setting in Northwest England. During the trial an increase in the availability of wound photography was noted (+37%), a reduction in inappropriate tissue viability nurse reviews (-10%) and the identification of mis-reported pressure ulcers (n=65). Challenges noted during the implementation included initial software compatibility issues with the tablets available on the wards and poor staff engagement. Overall, this initial trial indicates the potential safety, economic and service efficiency improvements that may be possible via implementation of mobile application technology in wound care. Further robust studies are needed to explore the initial findings of this trial in greater depth. Copyright © 2022, OmniaMed Communications Ltd. All rights reserved.
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OBJECTIVE: During the SARS-CoV-2 (COVID-19) pandemic, to prevent the transmission of the virus, the use of personal protection products and equipment were recommended by international and national organisations. The need to use it more frequently and for a long time can damage the skin of health professionals. The aim of this study was to estimate the prevalence and factors associated with skin lesions in health professionals resulting from the use of personal protective equipment (PPE). METHOD: This was a cross-sectional exploratory study through an online questionnaire. The first part of the questionnaire collected socio-labour characterisation data and the second part related to exposure factors. The variables were analysed according to the prevalence and the odds ratio (OR), within a 95% confidence interval (CI). RESULTS: Of the 398 participants who met the inclusion criteria, 65.3% were self-diagnosed with skin lesions: 37.3% with pressure injury, 25.8% with contact/allergic dermatitis and 2.7% with acne. Regarding the use of PPE, of the 240 professionals who reported using an N95 mask, 80.4% developed injuries, 70.4% of which related to a work regime of >6 hours per day (OR: 2.08, 95% CI: 1.79-2.42). CONCLUSION: The results of this study showed a significant prevalence of skin lesions in health professionals. Among exposure factors, the N95 mask and goggles stand out. Longer or more frequent exposure time to personal protective products and equipment proved to be important factors to be considered.
Subject(s)
COVID-19 , Humans , Cross-Sectional Studies , COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2 , Personal Protective Equipment/adverse effectsABSTRACT
Frugal innovation is a common philosophy in low-income settings due to limited access to resources. However, with both the increasing prevalence and clinical acuity of patients with wounds in the UK, it is essential that alongside innovation such as harnessing cutting-edge new technologies, frugal innovation is also pursued. This may improve both economic efficiency and patient outcomes. Frugal innovations were adopted throughout the COVID-19 pandemic and included opportunistic solutions such as video-conferencing services to run clinics. However, there are many more opportunities for frugal innovation in wound care, including the use of smartphone technology, which is already accessible to 99.5% of UK clinicians caring for wounds, or the simplification of wound-assessment processes using pulse oximeters as an alternative to dopplers, as in the Lanarkshire Oximetry Index. This article explores what frugal innovation is and how it could improve UK wound services. The authors invite clinicians working in wound care to consider their access to existing resources that may not be considered useful for wound-care processes and explore how these could be used to improve clinical outcomes.
Subject(s)
COVID-19 , Pandemics , Humans , PovertyABSTRACT
OBJECTIVE: More specific strategies are needed to support children requiring skin grafting. Our goal was to identify procedures that reduce operating times, post-operative complications, pain and length of hospital stay. Patient safety, optimal wound bed support and quick micro-debridement with locoregional anaesthesia were prioritised. Ultimately, a novel acellular fish skin graft (FSG) derived from north Atlantic cod was selected for use. METHOD: We admitted consecutive paediatric patients with various lesions requiring skin grafting for definitive wound closure. All FSGs were applied and bolstered in the operating room following debridement. RESULTS: In a cohort of 15 patients, the average age was 8 years and 9 months (4 years 1 month-13 years 5 months). Negative pressure wound therapy (NPWT) was given to 12 patients. Rapid wound healing was observed in all patients, with a wound area coverage of 100% and complete healing in 95% of wounds. Time until engraftment in patients receiving NPWT was reduced by about a half (to an average 12 days) from our standard experience of 21 days. Ten patients received locoregional anaesthesia and were discharged after day surgery. The operating time was <60 minutes, and no complications or allergic reactions were reported. Excellent pliability of the healed wound was achieved in all patients, without signs of itching and scratching in the postoperative period. This case series is the first and largest using FSG to treat paediatric patients with different wound aetiologies. We attribute the rapid transition to acute wound status and the good pliability of the new epidermal-dermal complex to the preserved molecular components of the FSG, including omega-3. CONCLUSION: FSG represents an innovative and sustainable solution for paediatric wound care that results in shorter surgery time and reduced hospital stays, with accelerated wound healing times.
Subject(s)
COVID-19 , Negative-Pressure Wound Therapy , Animals , Fishes , Humans , Negative-Pressure Wound Therapy/methods , Pandemics , Skin Transplantation/methods , Wound HealingABSTRACT
The COVID-19 pandemic has inhibited the practice of diabetic foot ulcer care, particularly in the community. Comprehensive theory-based nursing care is needed to prevent further complications. Unfortunately, a study combining theory with nursing care in diabetic foot ulcer care has not been explored. When caring for patients with diabetic foot ulcers, who are also at increased risk of severe complications from COVID-19, it is important to take a holistic view of the patient and consider all of their needs and the factors affecting them. Henderson's Need Theory and the 14 basic needs contained within it was chosen to be integrated in the care of patients with diabetic foot ulcers during the pandemic, with the hope that the findings will help nurses to optimise care in both hospital-based and community practice.