Amit Gefen is Professor of Biomedical Engineering and the Berman Chair in Vascular Bioengineering at the Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel

      Currently, the most commonly used dressing materials for the prevention of facial medical device-related pressure ulcers/injuries are hydrocolloids and foams. Often, clinicians who choose one type over the other are unaware of the underlying differences in material behaviours, and the biomechanical considerations and implications of their selection, in particular concerning the compatibility of these dressing types with skin. Accordingly, this article aims to compare the suitability of hydrocolloids versus foams for the specific purpose of facial medical device related pressure ulcer prevention, based on biomechanical considerations which are explained here in a non-technical language. In particular, the alleviation of localised and sustained tissue loads are the most fundamental requirement from any type of prophylactic dressing, and avoiding sharp stiffness gradients between the skin and the protecting dressing serves this purpose. The compressive stiffness matching ratio explained here is an intuitive and easy-to-implement biomechanical performance measure of this skin-dressing stiffness gradient. Specifically, the compressive stiffness of a dressing used for prophylaxis and the compressive stiffness of the skin region covered by the dressing are the most important and relevant properties to consider, given the common techniques of device attachment to skin which apply localised, intense compressive forces to the skin, such as for ventilation masks that are strapped to the head. Based on the above criterion, hydrocolloids exhibit poor biomechanical prophylactic efficacy in protecting healthy skin, and more so, in preventing injuries in fragile or aged skin. Foams, on the other hand, have stiffness properties that closely resemble those of human skin, and, though foam dressings by different manufacturers vary in their specific stiffness properties, some low-stiffness foams provide a near ideal stiffness matching with skin. Wound care professionals should adopt objective, standardised and quantitative research-based approaches in their clinical decision making processes, to grade and then select the optimal dressings for prophylaxis of injuries caused by medical devices. This article discusses an example basic bioengineering measure, i.e., the stiffness matching ratio, which should be demanded by clinicians and disclosed by manufacturers for best-practice.

Author: Anette Svensson Henriksson

Anette Svensson Henriksson is Senior Product Developer, Mölnlycke Health Care AB, Gothenburg, Sweden In this article, the results from simulated clinical use tests evaluating the performance of a single use negative pressure wound therapy (suNPWT) system (Avance® Solo NPWT System, Mölnlycke Health Care AB) are presented. This suNPWT system is designed with a negative pressure pump, a distal canister and an absorptive multilayer dressing, and introduces Controlled Fluid Management (CFM) Technology™. The performance was compared to those of two canister-less suNPWT systems, designed around absorptive multilayer dressings and solely relying on the capacity of the dressings to manage fluid through absorption and moisture vapour transmission (evaporation). Method: The technical performances of the suNPWT systems were evaluated with respect to fluid management and delivery of the intended negative pressure using a wound model simulating clinical use on a moderate exudating wound and a 3-day dressing change regimen. Results: With the canister-less suNPWT systems, a loss of performance of the intended negative pressure was observed as saturation of the dressing occurred during the 72-hour test time. In comparison, the canister-based suNPWT system continuously delivered the intended negative pressure to the simulated wound throughout the 72-hour testing time, without any saturation of the dressing observed. Conclusion: The results could be explained by the design of the canister-less suNPWT systems, managing fluid in the dressing only, and that dressing saturation impedes the delivery of the intended negative pressure. In comparison, the canister-based suNPWT system has the capacity to transport excess exudate and infectious material from the dressing to the canister, thereby reducing the risk of dressing saturation.

Amanda Dudley, Tiffany Ballentine, Tanya Cohn

Citation: Dudley A, Ballentine T, Cohn T (2022) Screening tool provides insight to the depths of diabetes-related Nursing. 26: [Early view publication]

Article points

1. Each day, people with diabetes are routinely faced with countless decisions regarding the management of their blood glucose levels.

2. This constant management can have emotional, psychological and physiological implications that can lead to diabetes-related distress.

3. If not identified through screening, diabetes related distress can lead to poor health outcomes and decreased self-care. Despite this, assessment is not routinely performed.

Key words - Burnout - Diabetes-related distress - Mental health

Authors Amanda Dudley, Critical Care Nurse; Tiffany Ballentine, Outpatient Surgical Nurse; Tanya Cohn, Associate Professor of Practice and Director of the Doctor of Nursing Practice Program, all at Simmons University, Boston, MA, USA.

      Diabetes-related distress differs from depression as it develops from the mental and emotional burden that comes from the constant management of diabetes. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. In order to potentially encourage providers to implement the 17-item Diabetes Distress Scale (DDS-17) into practice and clinic appointments with patients, the authors researched and analysed results from voluntary and anonymous participants with diabetes, aged 18 years and older, who completed demographic survey questions and the DDS-17. The results revealed that areas of statistically significant distress can be found in people recently diagnosed with diabetes and occurs more often in those with type 1 diabetes compared with type 2 diabetes.

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