Twice daily use of emollient moisturiser to prevent skin tears among frail older adults in a mental health setting: a narrative review

Skin tears are a significant problem for frail older patients, especially in a mental health setting. Furthermore, they go largely unreported. Frail older adults are vulnerable to dry, thin and fragile skin, which may lead to skin tears. Skin tears can cause unnecessary pain, discomfort and anxiety, as well as stress to patients, carers, and their families. They can also lead to prolonged hospitalisation. In a mental health setting, skin tears are often associated with friction, shear and skin trauma due to self-harm, aggression, psychotropic medications, poor nutrition, depression, a poor lifestyle and a lack of motivation. This paper reviews evidence related to the use of moisturisation as a preventive measure to reduce skin tears among frail older adults in mental health settings. It is evident that moisturising twice daily helps to prevent the incidence of skin tears in frail older adults. However, there is limited research for skin tears in the area of mental health.

KEY WORDS

Emollients

Frail older adult

Mental health

Prevention

Skin tears

Wounds

AYODELE AYENI

Tissue Viability Nurse Specialist, Hertfordshire Partnership University NHS Foundation Trust

Treatment-resistant pyoderma gangrenosum managed with maggot debridement therapy and hyperbaric oxygen therapy: a case study

ABSTRACT: Here we discuss the case of a patient with treatment-resistant pyoderma gangrenosum. We explore the difficulties in managing this condition and reveal the approaches tested in order to bring about clinical improvements.

KEY WORDS

Hyperbaric oxygen therapy

Maggot debridement therapy

Novel treatment

Pyoderma gangrenosum

Wound care

DANIEL LYONS

MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland

SARAH FLEMING MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland

MARIE DENHAM BSc, Beaumont Hospital, Beaumont, Dublin 9, Ireland

KAREN EUSTACE MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland

Standardising leg ulcer assessment and management in a prison environment

ABSTRACT: His Majesty’s Prison and Probation Service uses age 50 to describe ‘old age’ in prisons, with the average age of people dying in prison being 56 compared with 81 in the general population. Patients in custody are a uniquely vulnerable population with a disproportionately high burden of disease and an increased mortality rate compared with the wider UK population. Prison nurses manage a diverse and complex range of wound presentations, from acute trauma, self-harm wounds, complex burns, and chronic disease, requiring a range of wound care interventions, with one of the most challenging wound types being leg ulceration. A wound care strategy was developed to provide overarching support, to improve access to training, while developing the knowledge and skills to ensure safe practice. Furthermore we wanted to develop a cohort of passionate nurses with a specific interest in tissue viability who would maintain the wounds agenda, transform wound management, and more importantly, enhance timely wound healing for this vulnerable patient population.

KEY WORDS

Assessment

Education

Leg ulcer management

Prisons

Secure settings

UrgoKTwo

SARAH LAVER, RGN, Professional Nurse Advocate, Regional Primary Care Lead: Thames Valley and South Central, Practice Plus Healthcare Group

Overview of the NHS Type 2 Diabetes Path to Remission Programme

Chirag Bakhai GP, Luton, and Primary Care Advisor to the NHS Diabetes Programme

Citation:

Bakhai C (2023) Overview of the NHS Type 2 Diabetes Path to Remission Programme. Diabetes & Primary Care 25: 105–6

Randomized clinical trial of autologous skin cell suspension combined with skin grafting for chronic wounds

Z-C. Hu1, D. Chen2, D. Guo3, Y.-Y. Liang1, J. Zhang1, J.-Y. Zhu1 and B. Tang1

Departments of 1Burn Surgery and 2Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, and 3Department of Plastic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Correspondence to: Dr B. Tang, Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China (e-mail: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)

Background: Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates. This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment.

Methods: This randomized clinical trial enrolled patients with chronic wounds between March 2012 and December 2013. Patients who were assigned randomly to the active treatment received a split-thickness autograft combined with harvested skin cell suspension. Control patients received the split-thickness autograft alone. The primary outcome was the rate of complete wound closure by postoperative day 28. Analysis was by intention to treat. Patients who achieved wound closure were followed up for a minimum of 6 months to evaluate the quality of healing.

Results: A total of 88 patients were included, 44 in each group. More patients achieved complete wound closure in the skin cell group than in the control group (41 versus 34 patients; P = 0⋅035). Complete wound closure was observed at a median of 14 (95 per cent c.i. 12⋅0 to 16⋅0) days in the skin cell group and 20 (15⋅7 to 24⋅3) days in the control group (P = 0⋅001). The skin cell group had significantly fewer complications (4 versus 11 patients; P = 0⋅047). The autografted sites displayed better physical attributes and a reduced tendency for wound recurrence in the skin cell group.

Conclusion: Complementary split-thickness autologous skin grafting with autologous skin cells harvested using MYSEED细胞分选仪® technology improved the healing rate of chronic wounds.

Registration number: UMIN000011966 (http://www.umin.ac.jp/ctr).

Click here to watch video footage recorded by the author about the contents of this paper.

Paper accepted 29 September 2014

Published online in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9688

Expert Consensus on Clinical Management of T2DM Combined with Obesity Reversal Treatment in China (2023 Edition)

Gugen Xu*, Bo Chen, Writing Group for Expert Consensus on Clinical Management of T2DM Combined with Obesity Reversal Treatment in China#

Endocrinology Department, Guangdong Second Provincial General Hospital, Guangzhou 510310, China

*Corresponding author: Gugen Xu, Gugenxu@163. com

# This writing group includes Gugen Xu, Aisheng Wei, Bo Chen, Wanhong Chen, Tongfeng Zhao, Jian Guo, Bing Ji, Yinghong Du, Shiqun Liu, Zhenyu Zhang, Liangping Wu, Weiguo Zhao, Yi Shu, Haiyan Zhao, Zhaohui Li, Jianming Lin, Zhi Li, Wenying Wang, Xiao Zhu, Wei Lan, Xiaoli Li, Ge Li, and Kejing Zeng.

Copyright: © 2023 Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), permitting distribution and reproduction in any medium, provided the original work is cited.

Abstract: With lifestyle changes, the incidence of type 2 diabetes (T2DM) and obesity has significantly increased, becoming major chronic diseases that seriously threaten the health of China’s residents. Both domestic and international guidelines and consensus exist regarding the diagnosis and management of this disease. In recent years, T2DM treatment has focused more on new tactics that lean towards a patient-centered comprehensive management approach, replacing the traditional glucose-centered approach. Additionally, an increasing amount of evidence in medicine suggests that the reversal of diabetes is possible. However, there is currently no expert consensus on the clinical management of T2DM combined with obesity reversal treatment. Therefore, experts and scholars in China with extensive experience in T2DM combined with obesity reversal treatment have been invited to develop this consensus. The content includes early identification and diagnosis of T2DM combined with obesity, definition and mechanisms of diabetes reversal, disease assessment and grading, staging of diabetes and goals of reversal, the 2+N reversal strategy, inpatient system treatment combined with comprehensive outpatient management (including weight control, precise nutrition, scientific exercise, glucose-lowering medication, psychological intervention, rehabilitation therapy, and remote follow-up through online platforms), and evaluation of post-reversal efficacy. The aim is to further improve the level of T2DM combined with obesity reversal diagnosis, treatment, and management in China, and to implement the Healthy China strategy.

Keywords: Type 2 diabetes mellitus (T2DM); Obesity; Reversal treatment; Clinical management; Expert consensus

Online publication: November 22, 2023