WHS guidelines for the treatment of pressure ulcers-2023 update.

The major populations at risk for developing pressure ulcers are older adults who have multiple risk factors that increase their vulnerability, people who are critically ill and those with spinal cord injury/disease. The reported prevalence of pressure ulcers in the United States is 2.5 million. However, this estimate is derived from acute care facilities and does not include people who are living at home or in nursing facilities. Despite the implementation of hospital and facility-based preventive measures, the incidence of pressure ulcers has not decreased in decades. In addition to the burden of pain, infection and death, it is estimated that hospital-acquired pressure ulcers cost the health system $26.8 billion annually with over 50% of the cost attributed to treating Stage 3 and 4 pressure injuries. Thus, it is critical to examine the literature and develop guidelines that will improve the outcomes of this complex and costly condition. This guideline update is a compendium of the best available evidence for the treatment of Pressure Ulcers published since the last update in 2015 and includes a new section based on changing demographics entitled 'Palliative wound care for seriously ill patients with pressure ulcers'. The overall goal of the Wound Healing Society Guideline project is to present clear, concise and commercial free guidelines that clinicians can use to guide care, that researchers can use to develop studies that will improve treatment and that both clinicians and researchers can use to understand the gaps in our knowledge base.

Effect of Carbon Nanofiber Clustering on the Micromechanical Properties of a Cement Paste.

The use of carbon nanofibers (CNFs) in cement systems has received significant interest over the last decade due to their nanoscale reinforcing potential. However, despite many reports on the formation of localized CNF clusters, their effect on the cement paste micromechanical properties and relation to the mechanical response at the macroscopic scale are still not fully understood. In this study, grid nanoindentation coupled with scanning electron microscopy and energy dispersive spectroscopy was used to determine the local elastic indentation modulus and hardness of a portland cement paste containing 0.2% CNFs with sub-micro and microscale CNF clusters. The presence of low stiffness and porous assemblage of phases (modulus of 15-25 GPa) was identified in the cement paste with CNFs and was attributed primarily to the interfacial zone surrounding the CNF clusters. The CNFs favored the formation of higher modulus C-S-H phases (>30 GPa) in the bulk paste at the expense of the lower stiffness C-S-H. Nanoindentation results combined with a microscale-macroscale upscaling homogenization method further revealed an elastic modulus of the CNF clusters in the range from 18 to 21 GPa, indicating that the CNF clusters acted as compliant inclusions relative to the cement paste.

Compression garment service model: Facilitating access to compression garments through workforce and service redesign.

PROBLEM: Patients in Queensland have had difficulty in accessing lymphoedema services, particularly in rural and remote locations. DESIGN: The aim was to trial and evaluate a compression garment service model, to provide care for patients with lymphoedema closer to their homes. The service model trialled compression garment, selection, fitting and monitoring services for stabilised malignancy-related lymphoedema undertaken by generalist therapists. SETTING: Ten Hospital and Health Services in the Queensland public sector. KEY MEASURES FOR IMPROVEMENTS: The patients would have access to safe, quality services closer to their homes. STRATEGIES FOR CHANGE: The generalists were supported by telehealth coaching and supervision by lymphoedema therapists, an education program, resources and governance processes. EFFECTS OF CHANGE: Compression garment selection, fitting and monitoring by generalists (physiotherapists and occupational therapists without Level 1 Lymphoedema training), as defined in the service model, was safe, effective and evaluated positively by patients and health professionals. There was increased access to compression garment services provided by generalist therapists in rural and remote locations. LESSONS LEARNED: The service model implemented has the capacity to address workforce and service provision issues. It provides resources, education and training for clinicians to improve access to the provision of compression garment services.

Profiling the allied health staffing of Queensland Health inpatient general rehabilitation units.

OBJECTIVE: The purpose of this paper was to profile staffing levels for allied health (AH) professional and support staff in Queensland Health inpatient general rehabilitation services (at a given point-in-time) and compare them against established profession-specific standards and guidelines in order to provide a reference for future workforce planning for these services. METHODS: A statewide analysis of AH staffing in Queensland Health inpatient general rehabilitation services was undertaken during June-August 2011. Reported full-time equivalent positions (FTE) were compared to several established national and international benchmarks. Patient activity data was used to calculate the average length of stay (ALOS) and Functional Independence Measure (FIM) scores on admission. RESULTS: Sixteen facilities reported 202 FTE for a total of 466 general rehabilitation beds, with a resultant average workforce ratio of 0.43 FTE/bed. While several professional groups within specific services met established benchmarks, the majority failed to reach recommended staffing ratios. More than half the workforce (53%) was entry-level or consolidating clinicians. The FTE/bed ratios were compared against both patient ALOS and FIM scores on admission and showed a poor correlation. CONCLUSION: Across all included services statewide, there was significant variance in AH staffing levels and diversity in skill mix for inpatient general rehabilitation services.

Emergency care provision at the 2009 Special Olympics Great Britain.

BACKGROUND: The Special Olympics Great Britain (SOLGB) summer games 2009 were held in Leicester between 25 and 31 July. They involved 2413 athletes that were engaged in 21 different sports across 19 different locations. The onsite healthcare was provided by a specialist medical team. The hospital services available were at the local emergency department (ED) and the co-located urgent care centre (UCC). AIM: To assess the on-site provision required to support a large multisport event for people with learning disabilities and to ascertain the impact on the local hospital services. METHODS: On-site consultations were documented on SOLGB medical record forms. Referrals to the local ED and UCC were identified from the SOLGB medical notes or from the ED/UCC attendance codes, as a specific code was applied to all patients related to the games. RESULTS: 581 on-site consultations were documented at SOLGB 2009, of which 95% of these were for athletes. 477 treatments were completed in total, of which 444 were undertaken on-site (93%). 20 people attended the ED; there were no documented attendances at the UCC. 17 of the 20 attendances at the ED were athletes competing. CONCLUSION: Allocation of the healthcare team was appropriate, with the exception of one sport, where a doctor was moved from a nearby event to consult on 13 occasions. Attendances to the local ED and UCC were minimal. Therefore, the model of on-site medical care that was used, which led to minimal impact on NHS resources, will support the arrangements of medical requirements at future SOLGB games.

The perceived benefits and barriers of sport in spinal cord injured individuals: a qualitative study.

PURPOSE: This study explores what individuals with spinal cord injury (SCI) perceive to be the benefits of becoming involved in organized sport and identifies the barriers to participation. METHOD: Seven SCI athletes from a variety of sports were interviewed in a semi-structured format. RESULTS: 20 benefits and 18 individual barriers were identified and categorized into sub-themes: benefits were categorized into sub-themes of "socialization," "self-worth," "physical challenge" and "emotional." Barriers were grouped into "organization," "medical," "emotional," "a lack of available information" and "views held by others." CONCLUSION: A variety of benefits from participating in sport were identified, including socialization, the acquisition of knowledge from others, the development of greater awareness of health and well-being issues, weight maintenance, functional development and independence. Barriers identified included financial constraints, the lack of information regarding medical complications and sporting opportunities, and the need for able-bodied support. The findings have implications for the rehabilitation of individuals with SCI.

A report of the medical team activity at the 2009 Special Olympics GB.

OBJECTIVE: To quantify and categorise medical workload from the 2009 Special Olympics GB (SOL GB) which involved 2500 athletes with learning disabilities across 21 different sports supported by nearly 9000 family members, volunteers and staff over a 7-day period. DESIGN AND PARTICIPANTS: Prospective survey of all medical contacts that took place at the 2009 SOL GB with subsequent analysis of consultation rates, medical problems and medical activity. RESULTS: 581 medical consultations occurred during the 2009 SOL GB, with 95% of these for athletes. The majority of the athlete consultations were for musculoskeletal disorders, followed by skin wound care. Most athletes were judged fit to participate following their consultation. CONCLUSION: A large multisport event for athletes with learning disabilities carries a significant medical workload that has not been studied previously, with different sports having different individual risks and demands. The vast majority of consultations are for systemically well athletes that can be managed locally without necessity for hospital admission. This study identifies the quantity and nature of medical consultations undertaken during this event in an attempt to inform planning for future events.

Minimally invasive monitoring of cellulose degradation by desorption electrospray ionization and laser ablation electrospray ionization mass spectrometry.

Minimally invasive desorption electrospray ionization-mass spectrometry (DESI-MS) and laser ablation electrospray ionization-MS (LAESI-MS) were used to look for soluble cellulose degradation products produced by accelerated aging in unsized cotton paper. Soluble extracts from papers aged 144 to 26,856 hours were first analyzed in solution using traditional electrospray ionization-MS (ESI-MS). Results were compared to those from direct analysis of condensed phase degradation products extracted from the absorbent paper substrate using DESI-MS and LAESI-MS. ESI-MS results showed evidence of oligosaccharide degradation products ranging from cellobiose to cellononaose; using DESI-MS and LAESI-MS, products from cellobiose to cellodecaose and glucose to cellooctaose, respectively, were observed. As degradation proceeded, increased quantities of both low and high molecular weight oligosaccharides were observed. The analytical approaches developed in the control study were applied for the detection of degradation products in two naturally-aged books dating from the 19th century, both made from cotton and linen. Oligosaccharides ranging from glucose to cellopentaose were observed.

Hydrolysis of the amorphous cellulose in cotton-based paper.

Hydrolysis of cellulose in Whatman no. 42 cotton-based paper was studied using gel permeation chromatography (GPC), electrospray ionization-mass spectrometry (ESI-MS), and uniaxial tensile testing to understand the course and kinetics of the reaction. GPC results suggested that scission reactions passed through three stages. Additionally, the evolution of soluble oligomers in the ESI-MS data and the steady course of strength loss showed that the hydrolysis reaction occurred at a constant rate. These findings are explained with a more detailed description of the cellulose hydrolysis, which includes multiple chain scissions on amorphous segments. The breaks occur with increasing frequency near the ends of amorphous segments, where chains protrude from crystalline domains. Oligomers unattached to crystalline domains are eventually created. Late-stage reactions near the ends of amorphous segments produce a kinetic behavior that falsely suggests that hydrolysis had ceased. Monte Carlo simulations of cellulose degradation corroborated the experimental findings.