ABSTRACT
Healthcare professionals use words like "frustrating," "expensive," and "time-consuming" to describe chronic wound care. Healing a wound that has been present for an extended period of time is difficult. Often the problem is not just the wound but also the "woundedness" of the individual with the wound. The patient's needs in chronic wound care often continue over months, years, or even a lifetime. This article addresses more than the wound--it offers healthcare professionals' accounts of patient stories and their active involvement in the long journey toward chronic wound healing.
Subject(s)
Empathy , Epidermolysis Bullosa/nursing , Epidermolysis Bullosa/psychology , Leg Ulcer/nursing , Leg Ulcer/psychology , Long-Term Care/psychology , Nurse-Patient Relations , Patient-Centered Care , Pressure Ulcer/nursing , Pressure Ulcer/psychology , Wound Healing , Adaptation, Psychological , Aged , Aged, 80 and over , Child , Chronic Disease , Female , Holistic Health , Humans , Male , Middle Aged , Models, Nursing , Models, Psychological , Needs Assessment , Patient Participation , Self Care/methods , Self Care/psychologyABSTRACT
The successful topical treatment of chronic wounds requires adequate debridement, bacterial balance, and moisture balance. An ionized nanocrystalline silver dressing was evaluated through an uncontrolled, prospective study of a case series of 29 patients with a variety of chronic nonhealing wounds. The four arms of the study included nine patients with foot ulcers, six patients with venous stasis ulcers, two patients with pressure ulcers, and 12 patients with miscellaneous wounds. All wounds were assessed for the usual signs of clinical infection, with most of these parameters being measured and recorded. Microbiologically, bacterial load was determined via quantitative biopsies and semi-quantitative swabs. In general, the results showed a marked clinical improvement for the majority of wounds treated with the dressing. Among improved parameters included decreased exudate and decreased purulence. The quantitative bacterial biopsies did not show any decrease in organism numbers, although the semi-quantitative swabs indicated a decrease in the wound surface bacterial loading. This was indicative of the dressing's ability to reduce surface bacteria and achieve an element of bacterial balance in the superficial dermal compartment. The proposed mechanism of action for this ionized nanocrystalline based dressing is through bacterial and moisture balance within the superficial wound space compartment.
Subject(s)
Polyesters/therapeutic use , Polyethylenes/therapeutic use , Wound Infection/therapy , Wounds and Injuries/therapy , Algorithms , Anti-Infective Agents, Local/therapeutic use , Biopsy , Chemistry, Pharmaceutical , Chronic Disease , Debridement , Decision Trees , Exudates and Transudates , Humans , Nanotechnology , Nursing Assessment , Polyesters/chemistry , Polyesters/pharmacology , Polyethylenes/chemistry , Polyethylenes/pharmacology , Prospective Studies , Suppuration , Treatment Outcome , Wound Healing , Wound Infection/microbiology , Wound Infection/pathology , Wounds and Injuries/microbiology , Wounds and Injuries/pathologySubject(s)
Exercise Test/methods , Oxygen Consumption , Physical Endurance , Adolescent , Adult , Heart Rate , Humans , Time FactorsABSTRACT
Total serum creatine kinase (CK) and the MB fraction of CK (CK-MB) activities were measured in 36 patients with active rheumatic carditis and on 33 controls. There were no significant differences in either the total CK or the CK-MB between the two groups. However, eight out of the 36 carditis patients had received intramuscular injections (IMI) prior to the assay: this sub-group showed a significant elevation of the total CK but not the CK-MB. Ten carditis patients (without prior IMI) had repeat assays done after their rheumatic activity had subsided: the mean total CK, but not the CK-MB, fell to levels below control values although these were not statistically significant. The results show that CK-MB is not of value in assessing activity in rheumatic carditis. Further, in assessing the significance of elevated total CK in any clinical situation, the influence of IMI and of bed rest should be taken into account.
Subject(s)
Creatine Kinase/blood , Myocarditis/enzymology , Rheumatic Heart Disease/enzymology , Child , Humans , Injections, Intramuscular , Isoenzymes , Male , Myocarditis/blood , Rheumatic Heart Disease/bloodABSTRACT
Cortisol and prostaglandins were measured in umbilical cord blood obtained from 50 twin pregnancies at caesarean section performed either before or during labour. Umbilical artery cortisol concentrations did not differ between twin I and II before labour or in the latent stage. During active labour cortisol levels were significantly higher in twin I than in twin II. Maternal cortisol levels did not correlate with cord blood cortisol levels in either twin before active labour, nor did the rise in maternal cortisol correlate with the cortisol level in twin I; maternal cortisol levels did, however, correlate with cortisol levels in twin II during active labour. Prostaglandins E(PGE), F 2 alpha (PGF 2 alpha), 13,14-dihydro-15-keto F 2 alpha (PGFM) and ACTH were measured in cord vein blood. PGE values did not differ between twin I and II before active labour. During active labour PGE levels were significantly greater in twin I and correlated with raised cortisol levels. No differences were seen at any stage in PGE and PGFM levels between twins I and II although PGFM levels increased in both twins during active labour. ACTH and prolactin levels did not increase during labour and were similar in twins I and II. The rise in fetal cortisol during active labour is primarily of fetal origin and PGE may be involved in stimulating cortisol production in the fetus.
