Unstable nonunions of the distal part of the humerus.
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Bone Plates↗
Biomedical subjects
S Bale
Publications and source records attributed to S Bale.
Exploring the use of an alginate dressing for diabetic foot ulcers.
Few studies have investigated the use of dressings on patients with diabetic foot ulceration. This paper reports the results of a non-comparative, two-centre study investigating the performance characteristics of SeaSorb dressing in patients with this condition. This was an exploratory study to determine the potential use of this dressing, and not a large randomised control trial. All patients had diabetic foot ulceration of 1 cm or more in diameter, classified as Wagner grade I or II, with an ankle brachial pressure index of > 0.4. The investigators carried out objective assessments including photography and ulcer tracing as well as subjective assessments of exudate levels, wound bed condition, peri-ulcer skin condition, ease of application and removal of the dressing, dressing conformability, discomfort during dressing application and removal, and clinical signs of infection. Investigators recruited 41 patients in two sites (31 in site one and 10 in site two). Of these, the findings relating to 39 patients could be evaluated. The patients were treated for a maximum of six weeks or until the ulcer healed. The study found that 28.2% (11/39) of the ulcers healed within the six-week period. Overall, there was a significant reduction in mean ulcer area from 2.8 cm 2 to 1.02 cm 2 from week 0 to week six. The relative ulcer area showed a significant decrease from 100% to 33%. For patients who experienced ulcer pain (11 patients), its intensity decreased over the six weeks. Severe maceration was not reported for any patient throughout the study. Six patients required treatment for infection. A total of 12 adverse events were reported: seven mild to moderate and five severe. None were directly attributed to the study dressing.
Adult↗
Families infected with Trichophyton rubrum.
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Epidemiologic Methods↗
The effect of a radiant heat dressing on pressure ulcers.
The use of heat in wound healing has been demonstrated to aid oxygen flow and hence healing in acute wounds. However, the situation in chronic wounds is less clear. This study was designed to investigate the benefits of using a radiant heat therapy system in the treatment of Stage 3 and 4 pressure ulcers. Despite randomisation, patients receiving radiant heat therapy were more infirm than those receiving standard treatment. This prospective, single-centre, randomised trial resulted in an accelerated rate of healing for those receiving heat therapy compared to a standard treatment: time difference to 75% of original area = 6.4 days (p = 0.057), to 50% of original area = 9.6 days (p = 0.039), time to 25% = 7.2 days (p = 0.01). This new development warrants further investigation to fully assess the role of a thermoregulation system in chronic wound healing.
Aged↗
Association of HLA alleles and clinical features in patients with synovitis of recent onset.
OBJECTIVE: To determine how HLA alleles are associated with the clinical disease patterns of patients with synovitis of recent onset. METHODS: The HLA alleles A, B, C, DRbeta1, and DQbeta1 were determined in a cohort of 211 patients (mean age 42 years, 64% female, 79% white) with recent-onset synovitis in 1 or more peripheral joints. At a mean disease duration of 33 weeks, 98 patients (46%) met the American College of Rheumatology (ACR) criteria for rheumatoid arthritis (RA), 38 (18%) met the European Spondylarthropathy Study Group criteria for spondylarthropathy (SpA), and 75 (36%) were classified as having undifferentiated arthropathy (UA). Controls were racially matched healthy individuals (n = 244). RESULTS: Shared epitope (SE) alleles were significantly more common in rheumatoid factor-positive (RF+) patients fulfilling the ACR RA criteria than in other patients with early arthritis (65% versus 35%; P < 0.001). In addition, the RA patients had by far the highest frequency of radiographic erosions (52% and 39% in RF+ and RF- RA, respectively, versus 3% and 9% in SpA and UA patients, respectively; P < 0.0001). The presence of SE alleles was a particularly strong predictor of early erosions in the RF- RA patients (odds ratio [OR] 6.8, 95% confidence interval [95% CI] 1.2-45). The presence of 2 SE alleles or an associated DQbeta1*0301 (DQ7) or DQbeta1*0302 (DQ8) allele appeared to modestly increase the risk of early erosions, although these DQ alleles were in strong linkage disequilibrium with DRbeta1*0401, both in the patient and in the control populations. B27 was linked with the presence of SE alleles in the patients, including those patients fulfilling the RA criteria, but not in the controls (12% versus 3%; P < 0.001). Enthesitis was present in 23 (11%) of 211 patients, was highly associated with B27 (OR 4.2, 95% CI 1.5-11.5), and surprisingly, was not a feature specific only to the SpA group. The B8-DR3 haplotype was significantly increased in the patient subgroups compared with controls (17% versus 7%; P < 0.01), although the clinical significance of this association is unclear. CONCLUSION: This study of HLA associations in a diverse cohort of early synovitis patients emphasizes the complex degree of genetic interaction between alleles at several major histocompatibility complex loci, which regulates clinical phenotypes. In particular, SE and B27, while predisposing patients to characteristic clinical syndromes, had an unexpected degree of association in this cohort, perhaps explaining the overlap in clinical features in many patients.
Adult↗
The dynamin-related GTPase Dnm1 regulates mitochondrial fission in yeast.
The dynamin-related GTPase Dnm1 controls mitochondrial morphology in yeast. Here we show that dnm1 mutations convert the mitochondrial compartment into a planar 'net' of interconnected tubules. We propose that this net morphology results from a defect in mitochondrial fission. Immunogold labelling localizes Dnm1 to the cytoplasmic face of constricted mitochondrial tubules that appear to be dividing and to the ends of mitochondrial tubules that appear to have recently completed division. The activity of Dnm1 is epistatic to that of Fzo1, a GTPase in the outer mitochondrial membrane that regulates mitochondrial fusion. dnm1 mutations prevent mitochondrial fragmentation in fzo1 mutant strains. These findings indicate that Dnm1 regulates mitochondrial fission, assembling on the cytoplasmic face of mitochondrial tubules at sites at which division will occur.
Crosses, Genetic↗
Clinical evaluation of a new pressure-relieving mattress.
In introducing a new mattress into practice it is important to evaluate its performance from both the patient's and nurse's perspective. A total of 20 patients admitted to the integrated medical unit were recruited and nursed on a new pressure-relieving mattress offering two modes of pressure relief (Duo). All patients had been recently admitted to hospital and were considered to be 'at very high risk' of developing a pressure ulcer, with an initial Waterlow score > 20. Data were collected on admission, mid-point (three to four days) and study exit (seven days). The primary objective was to investigate the condition of patients' skin and the mode of choice for pressure relief. The secondary objective was to investigate reasons for nurses' and patients' choices. Structured interviews were conducted with the patient, ward nurse and research nurse whenever possible. Nineteen patients maintained or improved their skin condition during the evaluation.
Aged↗
Challenging the pressure sore paradigm.
This study determines the effectiveness of a new low-unit-cost support system in patients at very high risk of developing pressure sores. In a prospective randomised controlled trial, a low-pressure inflatable mattress and cushion system (Repose) was compared to a dynamic support mattress (Nimbus II) used in conjunction with an alternating-pressure cushion (Alpha TranCell) in 80 patients with fractured neck of femur and high scores on a pressure sore risk assessment scale. All patients received best standard care, including turning at regular intervals. Skin condition was assessed in 17 locations on admission, preoperatively, and seven and 14 days postoperatively. No difference was found between the groups in skin condition or the occurrence and severity of pressure sores at any time point.
Aged↗
A comparison of two amorphous hydrogels in the debridement of pressure sores.
This study compared the efficacy of two hydrogel dressings in the debridement of necrotic pressure sores. This randomised, controlled, assessor-blind, clinical trial involved 50 patients whose wounds were assessed weekly using computerised wound analysis for four weeks or until debrided. Debridement was identified when there was 80% red granulation tissue present and no sign of necrosis. There were no statistically significant differences in comfort, wound odour, surrounding skin condition or time to debridement between the two groups.
Adult↗
The use of cultured dermis in the treatment of diabetic foot ulcers.
The aim of this open, non-comparative study was to assess the potential benefit of tissue-engineered human dermis (Dermagraft) in healing long-standing, difficult-to-heal diabetic foot ulcers, and the practicality of its use in the UK. Six patients with full-thickness neuropathic diabetic foot ulcers which extended into subcutaneous tissue and had an area > 1 cm2 were included. The treatment was applied weekly for eight weeks and the patients were followed for a total of 24 weeks. Four patients completed the study, showing improvement ranging from a reduction of 26% in ulcer area to complete healing. Two patients were withdrawn after developing complications not associated with the treatment. We conclude that this tissue-engineered human dermis has a role in the treatment of diabetic foot ulcers as part of a comprehensive treatment package. A study to confirm effectiveness in a comparative trial and optimise patient selection is indicated.
Adult↗
Costs of dressings in the community.
This study compares the costs of dressings used in the treatment of patients with a variety of wound aetiologies. The two dressings investigated were a hydrocolloid dressing and a hydrocellular dressing. Secondary objectives included a comparison of dressing durability, time to complete healing, ease of wound cleansing and dressing removal. The study was an open prospective single-centre randomised parallel group trial involving 100 patients, treated in the community, who were randomised to the two dressing groups. For all aetiologies except pressure sores, the costs of the hydrocolloid dressing were less than the costs of the hydrocellular dressings. Similar healing rates were observed in the leg ulcer and 'other wound' groups. There were, however, significant differences in the number of healed wounds observed in patients with pressure sores treated with the hydrocellular dressing.
Aged↗
A comparison of two dressings in pressure sore management.
This study compared a polyurethane foam dressing with a hydrocolloid dressing for ease of application and removal, adhesion, conformability, absorbency and wear time. A randomised study was carried out, including 61 patients with stage two or three pressure sores in five centres in the UK. Dressings were applied for up to 30 days and assessments were carried out at each dressing change. The results indicated that both dressings are easy and convenient to apply; absorbency and ease of removal were significantly better with the polyurethane foam dressing than the hydrocolloid dressing; wear times were similar.
Aged↗
A guide to wound debridement.
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Bandages↗
Evaluation of a new polyurethane foam dressing.
The treatment of moderately to heavily exuding wounds requires a dressing that will remove excess exudate while ensuring optimum conditions at the wound site and preventing maceration of the surrounding skin tissue. This prospective, stratified, randomised clinical trial was designed to assess the performance and safety of a new polyurethane foam dressing compared with a hydrocellular dressing. Both dressings are currently available to community nurses for the treatment of these wound types. Sixty-one patients recruited to the trial. They were grouped according to wound type: 20 leg ulcers, 20 Grade 2 or Grade 3 pressure sores and 21 other wounds that included traumatic, acute and chronic wounds and burns. Patients were randomized to treatment and dressing changes and assessments were undertaken as required. Condition of the wound and surrounding skin, comfort, ease of use and leakage from the dressing were monitored at each assessment. Treatment continued for six weeks or until the wound was lightly exuding (defined as absence of leakage with the dressing remaining in place for more than four days on two consecutive occasions). Photographs and tracings of the wounds were taken weekly. The results showed that the two dressings were similar in performance in that they could remain in place for approximately 2.5 days, irrespective of wound type. There were no statistically significant differences in surrounding skin condition, reduction in wound size, patient comfort or ease of application and removal.
Aged↗
A study to compare two film dressings used as secondary dressings.
Dressings manufactured from adhesive polymeric films have been used extensively in wound management for about 20 years. This report describes the results of a trial designed to compare the performance of two such dressings, used as secondary dressings, in a multi-centre randomised controlled community study involving 100 patients. Independent analysis of the study data revealed that, after adjusting for other effects, no genuine difference was demonstrated between the dressings in terms of their ability to resist wrinkling or prevent maceration (the primary outcome variable).
Adult↗
A comparison of two dressings in the management of chronic wounds.
A hydropolymer dressing (Tielle) and a hydrocolloid dressing (Granuflex) were compared in a randomised controlled clinical study involving 100 patients with leg ulcers and 99 patients with pressure sores in the community. Statistically significant differences in favour of the hydropolymer dressing were detected for dressing leakage and odour production, but no statistically significant differences were recorded in the number of patients with either leg ulcers or pressure sores who healed in each treatment group.
Aged↗
Dressings for treating cavity wounds.
Two treatment protocols for the management of patients with non-infected cavity wounds were studied, using data obtained from both the community and the outpatients clinic. Patients were treated with either a polyurethane foam hydrophilic dressing (Allevyn) or a calcium sodium alginate dressing (Kaltostat). Although alginate fibres were found to be incorporated in tissue, both dressing regimes were found to be easy to use, effective and acceptable to patients and clinicians.
Adult↗
The management of extensive pressure sores.
A case report describing the management of a patient presenting with severe skin excoriation and neglected pressure sores.
Adult↗