Calidad de vida de persona con heridas complejas en Cartagena, Colombia / The quality of life for people suffering from complex wounds in Cartagena, Colombia

Objetivo Estimar la Calidad de Vida Relacionada con Salud-CVRS- de personas con heridas complejas que reciben cuidados en una Institución Prestadora de Servicios de Salud Extramural en Cartagena, durante mayo-junio de 2010. Materiales y métodos Estudio cuantitativo, descriptivo, cuya población y muestra fueron 93 personas adultas que reciben cuidados en el programa de heridas complejas de una Institución Prestadora de Servicios de Salud Extramural de la ciudad de Cartagena. Se aplicó un cuestionario sobre características socio demográfico, una guía de observación sobre las características de las heridas y el "Índice Multicultural de Calidad de Vida". Para el análisis estadístico se empleó el software SPSS 12. Resultados El promedio de edad fue de 59,3 años; predominó género femenino, 61,3 %; estado civil casado, 43,0 %; ocupación hogar, 38,7 %; escolaridad primaria, 38,7 %; y estratos socio-económicos 2 y 3, 68,8 %. El 93,5 % de los participantes tienen afiliación a la seguridad social en salud. Las heridas complejas se caracterizaron por presentar mayor porcentaje en la fase proliferativa de la cicatrización, 80,6 %; medir de seis a diez centímetros, 63,4 %; no reportar infecciones, 85 %; no presentar amputación, 90,3 %; ni dolor relacionado con la herida, 52,7 % y presentar limitación física relacionada con la herida, 66,7 %. Conclusiones Las personas perciben su CVRS como mala, resaltando con baja puntuación las dimensiones de plenitud personal, funcionamiento ocupacional y bienestar físico y psicológico.

Objective Estimating the health-related quality of life (HRQOL) of people suffering complex wounds who were receiving care in an extramural health service provider institution in Cartagena during May-June 2010. Materials and methods This was a quantitative, descriptive study where the population/sample consisted of 93 adults receiving care in an extramural health service provider institution's complex wounds program in the city of Cartagena. A questionnaire regarding socio-demographic characteristics, an observational guide on the characteristics of injuries and the Multicultural Quality of Life Index were used. SPSS 12.0 software was used for the statistical analysis. Results Mean age was 59.3 years, females predominated (61.3 %), 43.0 % were married, 38.7 % were housewives, 38.7 % had finished primary education, 68.8 % came from socioeconomic levels 2 and 3 and 93.5 % of the participants had health social security affiliation. Complex wounds were characterised by a greater percentage being in the proliferative phase of healing (80.6 %), measuring six to ten inches (63.4 %) no infection being reported (85%), no amputation (90.3 %) or wound-related pain (52.7 %) and presenting physical limitations related to the wound (66.7 %). Conclusions People perceived their HRQOL as poor, their low scores highlighting low personal fulfillment, occupational functioning and physical and psychological wellbeing.

[The quality of life for people suffering from complex wounds in Cartagena, Colombia]. / Calidad de vida de persona con heridas complejas en Cartagena, Colombia.

OBJECTIVE: Estimating the health-related quality of life (HRQOL) of people suffering complex wounds who were receiving care in an extramural health service provider institution in Cartagena during May-June 2010. MATERIALS AND METHODS: This was a quantitative, descriptive study where the population/sample consisted of 93 adults receiving care in an extramural health service provider institution's complex wounds program in the city of Cartagena. A questionnaire regarding socio-demographic characteristics, an observational guide on the characteristics of injuries and the Multicultural Quality of Life Index were used. SPSS 12.0 software was used for the statistical analysis. RESULTS: Mean age was 59.3 years, females predominated (61.3%), 43.0% were married, 38.7% were housewives, 38.7% had finished primary education, 68.8% came from socioeconomic levels 2 and 3 and 93.5% of the participants had health social security affiliation. Complex wounds were characterised by a greater percentage being in the proliferative phase of healing (80.6%), measuring six to ten inches (63.4%) no infection being reported (85%), no amputation (90.3%) or wound-related pain (52.7%) and presenting physical limitations related to the wound (66.7%). CONCLUSIONS: People perceived their HRQOL as poor, their low scores highlighting low personal fulfillment, occupational functioning and physical and psychological wellbeing.

Exudate, infection and patient quality of life.

Efficient and cost-effective management of excessive wound exudate continues to present unique challenges to nurses. Accurate patient and wound assessment is essential to inform the treatment and selection of suitable dressings. The wide range of modern wound management products should be sufficient to meet the needs of every wound type at all phases of healing, and as circumstances change. However, there are still situations in which nurses are having to change dressings a number of times in 24 hours to prevent maceration (i.e. the softening and whitening of skin that is kept constantly wet), soiling, and the potential for cross-infection. There is no easy solution to the problem, but as nurses become more knowledgeable about identifying and managing the causes of excessive exudate, the available management options, and, as dressing materials become more sophisticated, practice should improve in this area.

Self-management of injection-related wounds among injecting drug users.

Injection-related wounds are an important complication of injection drug use. This study describes behaviors related to self-management of injection-related wounds and identifies factors associated with behaviors that may increase the potential for harm. We conducted interviews with 101 injecting drug users in Washington, DC. A total of 82 (81.2%) injecting drug users reported ever having an injection-related wound, and of these 93.9% reported self-management of their wounds. The most commonly reported behaviors were cleaning and applying ointment to wounds; however, several participants engaged in behaviors determined to be more potentially harmful, including acquiring antibiotics without prescriptions and manipulating their wounds. In multivariate analysis, injecting drug users who had ever injected amphetamines were more likely to engage in potentially harmful self-management behaviors (adjusted odds ratio = 4.38; 95% confidence interval = 1.15-16.64). Self-management of injection-related wounds is common and certain behaviors may increase the potential for harm. Further research is needed to best focus efforts to improve wound care for injecting drug users.

Clinical experiences of using a silver hydroalginate dressing in Austria, Switzerland and Germany.

This retrospective study, which involved patients with a range of colonised or infected wounds from 12 central European wound-care centres, found that this dressing combated infection, reduced pain and promoted healing.

Topical metronidazole for the treatment of wound odor: a review of the literature.

Unpleasant odor is a frequent and distressing concern of persons who have wounds, as well as their family members and caregivers. In some instances, standard nursing interventions such as increasing the frequency of dressing changes will not be sufficient to address wound malodor. A review of the literature to summarize research findings about topical metronidazole used to decrease wound odor was conducted. Fifteen (15) studies were identified: seven case reports/series; six descriptive longitudinal studies; and two controlled clinical trials. Metronidazole was used as a 1% solution or, more frequently, as a 0.75% or 0.80% gel. Two reported adverse effects were skin irritation and a burning sensation. Generally, topical metronidazole was reported to result in a reduction or eradication of wound odor, decrease in wound drainage, improvement in wound appearance, decrease in surrounding cellulitis, halting of tissue necrosis, and decrease in pain. Although nurses report success with sprinkling crushed metronidazole pills on wounds, no published reports of this method of topical application are available. Topical metronidazole may be considered as an option for the management of malodorous wounds and additional randomized controlled trials with adequate sample sizes and comparison to products noted to decrease odor are warranted. While topical metronidazole for the treatment of malodorous wounds presently is off-label, perhaps such studies will result in the addition of malodorous wounds to the list of its indications.

Evaluation of a new silver foam dressing in patients with critically colonised venous leg ulcers.

OBJECTIVE: To evaluate the performance (efficacy and safety) of an absorbent dressing impregnated with silver salts (UrgoCell Silver) in the management of leg ulcers with clinical signs of critical colonisation. METHOD: This was a prospective multicentre non-comparative phase III clinical trial. Patients were assessed weekly for up to four weeks. Assessment included clinical assessment of critical colonisation (severe spontaneous pain between dressing changes, erythema, oedema, malodour and heavy exudate), wound area tracing and photography. Acceptability was documented by the nursing staff when dressings were changed between two weekly evaluations. RESULTS: Forty-five leg ulcers were included. At baseline the mean number of clinical signs of critical colonisation per ulcer was 3.6 +/- 0.7, which decreased to 1.2 +/- 1.2 at the end of the fourth week of follow-up (an average reduction of 2.3 +/- 1.3, p < 0.001). Oedema, malodour, erythema and spontaneous pain disappeared at the fourth week in 80%, 70%, 69% and 65% of the treated ulcers respectively. Compared with baseline, the mean reduction in ulcer area was 35.0 +/- 58.0% (median 33%, p < 0.001) after the four weeks treatment. Granulation tissue covered a mean 77% of the ulcer surface area at four weeks, compared with 41% at baseline. Only three local events were documented: contact dermatitis, a burning sensation and erythema. CONCLUSION: The results suggest that the test dressing had a favourable influence on the wound prognosis, and was well tolerated and accepted in the treatment of venous leg ulcers with clinical signs of critical colonisation.

One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia.

INTRODUCTION: Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. METHODS: This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). RESULTS: Multiple large flap lacerations (2 x 3 to 60 x 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. CONCLUSION: Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.

Prontosan wound irrigation and gel: management of chronic wounds.

Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.

Wound infection and colonisation.

Many wounds seen by nurses will involve infection and colonisation. To enable nurses to correly assess and manage these wounds, infection and colonisation are explained and options for management discussd.

A topical metronidazole gel used to treat malodorous wounds.

Patients with malodorous wounds often experience social isolation, depression, shame, embarrassment and poor appetite, all of which can have a negative impact on their quality of life. The healthcare professionals caring for them face difficult clinical challenges in terms of treating the cause and managing the symptoms. This study employed a randomized, placebo-controlled double blind design to investigate the effectiveness of metronidazole gel on wound malodour, the main focus of this article. In addition, changes in self-report of mood state were also explored. There was a 100% success rate for the metronidazole gel, mostly within 3 days, with no adverse events reported. As there was a 76% success rate in the placebo group, there was no significant difference in success rates between the two groups. Odour ratings given by patients and nurses were significantly correlated (P<0.001). There was no significant difference in mood state between the groups over time. This study provides some evidence to support the use of metronidazole gel in the treatment of patients with malodorous wounds, but indicates the need for further research in this area.

Hand infection associated with clenched fist syndrome in residents of long-term care facilities.

1. Clenched fist syndrome is a clinical entity in which no organic disease can be found. 2. The syndrome usually follows a minor inciting incident and is associated with swelling, pain, and paradoxical stiffness. 3. Patients with severe forms of clenched fist syndrome may experience infections of the palm or joints.

Infected wounds and repeated septicemia in a case of factitious illness.

During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions Rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.