The Legs Matter campaign: buzzing about legs and feet!

MARGARET SNEDDON Chair, British Lymphology Society, Member of Legs Matter Coalition, Hon. Sen Res Fellow, University of Glasgow

Frailty Syndromes: should wounds be considered an additional syndrome?

SAMANTHA HOLLOWAY Academic Editor, Wounds UK; Reader, Programme Director, Cardiff University School of Medicine, Cardiff

"...chronic wounds could be considered an additional frailty syndrome based partly on the notion of skin failure"

Effects of a breathable silk-like, 3-layer ventilating mattress sheet on selfrepositioning, repositioning support and pressure ulcer incidence; a pragmatic observational study

MWF van Leen is Elderly Care Physician, Ruitersbos, Breda Netherlands;

WIJ van Ratingen is Biometrician, WvR research & development, Neer, Netherlands;

JMGA Schols is Professor of Old Age Medicine, Caphri, Dept. Health Services Research, Maastricht University, Maastricht, Netherlands

      Besides pressure relief by using special support surfaces and repositioning, pressure ulcer guidelines on prevention and treatment nowadays also advise on shear force reduction and regulation of the microclimate by using silk-like mattress covers instead of cotton covers. Skincair® (Sense Textile), a newly developed breathable silk-like, 3-layer ventilating mattress sheet, reduces shear forces and is able to absorb excess fluid, which may result in better self-repositioning in bed, reduced nursing repositioning support and enhanced pressure ulcer (PU) prevention. Moreover, reducing the amount of fluid and improving the microclimate may result in lesser damage of the skin overall. A total of 112 residents of eight nursing homes at risk of PU development, participated in a 12-weeks observational study. Residents were selected, based on the following criteria: age >65 year, Braden score <18, laying on standard cotton mattress cover around a preventive mattress and need of nursing support for repositioning. During the first 6 weeks, all 112 residents laid on the cotton sheet (control period) and during the second 6 weeks all residents laid on the new 3-layer ventilating mattress sheet (intervention period) while receiving care as usual. There were no mattress changes during this 12-week period. On the cotton sheet all residents were unable to perform self-repositioning in bed and, therefore, needed nursing support for repositioning. At the end of the 6 weeks intervention period, 69.6% of the residents were able to change their position in bed without nursing support, implicating that the requirement of nursing support for repositioning decreased significantly. The development of pressure ulcers (PUs) was also monitored. In the control period, when residents were laying on the cotton sheet, 22 residents developed 41 PUs (category 2). In the intervention period, two residents developed a category 2 PU and one resident showed deterioration of a category 2 into a category 3 PU. This study showed that the use of the new breathable silk-like, 3-layer ventilating mattress sheet, which acts as the direct patient interface, improved self-repositioning of patients in bed and led to less need for nursing support during repositioning. Moreover, a lower PU incidence was observed.

Lower Extremity Artery Disease and Cognitive Impairment

Agnieszka Turowicz1,2* , Alina Czapiga3 , Maciej Malinowski2 , Tadeusz Dorobisz2 , Bartłomiej Czapla1 and Dariusz Janczak2

Abstract

Background: The association between cerebrovascular disease and cognitive impairment is well known, but the impact of lower extremity arterial disease (LEAD) on neuropsychological performance is less established.

Objectives: The aim of this study was to investigate the infuence of LEAD on cognitive impairment.

Materials and Methods: A total of 20 patients with LEAD, classifed by Fountain’s stage IIB, qualifed for revasculari‑zation surgery has been included in this prospective study. Neuropsychological assessments have been done using MoCA and CANTAB test. Fifteen patients qualifed for hernia surgery, without peripheral artery disease served as a control group. Linear regression model has been applied to assess the connection between LEAD and cognitive

Results: Diferences between the study groups reach signifcance in both MoCA and CANTAB test. In MoCA test, patients with LEAD had lower levels of performance in attention (p = 0.0254), visuospatial/executive (p = 0.0343) and delayed recall (p = 0.0032). The mean MoCA score was below 26 points. In CANTAB test, patients with LEAD performed worse in visual memory and learning. After adjusted for common cerebrovascular risk factors, LEAD was signifcantly correlated with cognitive impairment defned as MoCA score < 26 points.

Conclusions: Lower extremity artery disease is associated with cognitive impairment independently of cerebrovas‑ cular risk factors.

Keywords: Lower extremity artery disease, Cognitive impairment, Atherosclerosis

Is there a place for surgical site assessment using new imaging modalities during routine clinical care? A review of dressing use and changes from an online survey

Abstract: The care and management of surgical incisional wounds continues to attract both interest and concern, due to continued high rates of surgical site infection (SSI) and morbidity. Novel approaches to objective wound assessment using noninvasive imaging modalities show promise in providing independent, objective wound assessment but only with the proviso that the wound is visible and can be ‘seen’ by the imaging detector.

Methods: An online semi-structured questionnaire was distributed via Survey Monkey to tissue viability nurses. Data was summarised descriptively, with responses relating to participant demographics and use of wound dressings tabulated. Key variables were also cross tabulated to investigate possible associations between variables. An economic analysis was conducted to estimate average weekly costs associated with changing and applying dressings, including both staff and equipment costs. 

Conclusion: The largest type of dressing products currently in use were nonadherent. Dressing changes took place approximately twice per week: more frequently if wounds were assessed/diagnosed as infected. The majority of wound assessment and dressing changes were undertaken by band 5, 6 or 7 nurses. There is a potential role for non-invasive infrared thermography to stratify risk of later SSI based upon the temperature distribution across wound site and adjacent skin territories. Early and objective interventions for early wound infection can reduce hospital inpatient stay, community visits, antimicrobial usage, patient morbidity and healthcare costs related to wound infection.

KEY WORDS  Imaging  Infrared  Dressing change  Dressings, treatment  Pay grade  Regime  Sonography  Surgical wound

PASANG TAMANG Postgraduate Researcher School of Human and Health Sciences, University of Huddersfield, UK.

CHARMAINE CHILDS PhD, Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK

JOHN STEPHENSON, PhD, Senior Lecturer in Biomedical Statistics, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield

KAREN OUSEY, PhD, Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention - University of Huddersfield Department of Nursing

Local antibiotic delivery: early intervention in infection management strategy

Chadwick P, Ahmad N, Dunn G, Elston D, Fisher N, Haycocks S, Kosnarova P, Morley R, Redfearn V, Smith M, Spruce P and Townsend R

Citation: Chadwick P, Ahmad N, Dunn G et al (2022) Local antibiotic delivery: early intervention in infection management strategy. The Diabetic Foot Journal 25(2): 44–52

Key words  - Foot infection  - Local delivery of antibiotics  - Targeted antimicrobial therapy

Authors

Prof Paul Chadwick is (Lead & Facilitator) Visiting Professor, Birmingham City University, UK; Noel Fisher is Consultant Orthopaedic Surgeon, Macclesfield Hospital, UK; Naseer Ahmad is Consultant Vascular Surgeon, Manchester Royal Infirmary, UK; George Dunn is Advanced Podiatric Specialist (High Risk), East Cheshire NHS Trust, UK; Prof Rob Townsend is Consultant Medical Microbiologist, Sheffield Teaching Hospitals NHS Foundation Trust, UK; Rob Morley is Consultant Podiatric Surgeon, UK; Debra Elston is Specialist Community Podiatrist, Heywood, Middleton and Rochdale, NHS Pennine Care, UK; Michelle Smith is High Risk Foot Team Podiatrist, Tameside and Glossop Integrated Care Foundation Trust, UK; Pavla Kosnarova is Consultant Diabetologist, Barnsley Hospital, UK; Victoria Redfearn is Wound Care Specialist Podiatrist, The Robert Hague Centre for Diabetes and Barnsley Hospital, UK; Samantha Haycocks is Consultant Podiatrist (High Risk), Salford Royal Foundation Trust, UK; Pamela Spruce is Clinical Director TVRE Consultant, UK

Article points

1. Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes but effective treatment can be disrupted by complications developing with their use

2. A method of delivering antibiotics directly to the site of infection, via antibiotic loaded beads, in addition to systemic use was debated by a multidisciplinary expert team of clinicians

3. These discussions resulted in the creation of a ‘tool kit’ of documents developed to support the safe and effective use of Stimulan by podiatrists in clinical practice

Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes. However, effective treatment can be disrupted by complications developing with their use, including allergic reactions, antibiotic-resistant organisms, the risk of clostridium difficile and possible organ toxicity. Poor vascular perfusion can also limit the availability of antimicrobial therapy to infected tissue. A method of delivering antibiotics directly to the site of infection, in addition to systemic use was debated by a multidisciplinary expert team of clinicians. Stimulan® (Biocomposites Ltd) is a system where antibiotics are mixed with calcium sulfate paste to form small beads. These can be placed in the foot wound following debridement, within a framework of standard best practice. The antibiotics are then released at therapeutic concentrations to the site of infection. As a result of these discussions, a ‘tool kit’ of documents was developed to support the safe and effective use of Stimulan by podiatrists in clinical practice. These could be adapted to meet the requirements of local protocols for care and, as a result, deliver additional antibiotic therapy to the infected wound.