Cath Lab Digest

Abstract: An ileal conduit is the most common urinary diversion following radical cystectomy for invasive bladder cancer. Unlike internal complications commonly described in urological literature, reports about the incidence of external complications are sparse. A Medline database review (1996–2008) of English-language literature was conducted to: 1) describe and compare external stoma and peristomal complications and complication rates among outpatients with ileal conduit diversion following radical cystectomy, and 2) summarize commonly used prevention and management strategies. Four

Index: Ostomy Wound Manage. 2012;58(2):34–40.

Abstract

  The validity and reliability of the Braden Scale for pressure ulcer development has been established in a variety of patient care settings, but studies suggest the scale does not capture risk factors in surgical patients. The purpose of this meta-analysis was to assess the predictive validity of the Braden Scale for pressure ulcer development in surgical patients. A literature search using PubMed and Web of Science databases (through July 2011) was conducted to identify all clinical studies on predicting pressure ulcers in surgical patients using the Braden Scale. To be eligible for inclusion, studies had to include sensitivity (true positive rate, TPR) and specificity (true negative rate, TNR) results or include sufficient data to calculate these factors. Study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument, and two-by-two tables of predictive validity were constructed from each article. Meta-analysis for predictive validity was performed, including calculation of pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), construction of summary receiver operating characteristic (SROC) curves, and overall diagnostic accuracy (Q*). Three studies (N = 609 patients) met the meta-analysis inclusion criteria. The pooled estimates for sensitivity and specificity were 0.42 (95% CI: 0.38 to 0.47) and 0.84 (95% CI: 0. 83 to 0.85), respectively, yielding a combined DOR of 4.40 (95% CI: 2.98 to 6.50). The area under the ROC curve (AUC) was 0.6921 ± 0.0346, and the Q* was 0.6466 ± 0.0274. Significant heterogeneity was noted between the included studies with Q value 34.49 (P = 0.0321), and I² for pooled sensitivity, pooled specificity, and pooled DOR was 88.7%, 98.6%, and 39.1%, respectively. Although the observed heterogeneity between studies may have affected the results, the low values for overall diagnostic accuracy (Q*) and diagnostic capability (AUC) indicate the Braden Scale has low predictive validity for pressure ulcer risk in surgical patients. A new pressure ulcer risk assessment scale for surgical patients should be developed and tested.

Keywords: pressure ulcer, surgical patients, Braden Scale, predictive validity, meta-analysis

Potential Conflicts of Interest: none disclosed

Index: Ostomy Wound Manage. 2008;54(6):50-65.

  Providing care for patients with challenging wounds and comorbidities requires an open mind. When Ms. T, an elderly woman with schizophrenia and a chronic diabetic foot ulcer that was not responding to treatment, presented at Victory Memorial Hospital Diabetic Foot Clinic (VMH DFC), Brooklyn, NY, care providers needed a plan that allowed consideration of all available care options to achieve the best outcomes.

  The well-known nursing theorist/researcher Sister Callista Roy’s¹ perspective on the human experience can be easily applied in wound care. On the sensitive relationship between man and the environment, Sister Roy writes about an ongoing adaptation, survival, and resilience as part of a journey through life. Similarly, wound care clinicians continually address the issue of maladaptation as a factor in the breakdown of the integumentary system. When the skin – the organ of temperature regulation and the major barrier to microbial invasion – has been compromised, the body is in danger of invasion by organisms that can lead to sepsis and death. In this case study of a patient with a diabetic foot ulcer, the patient’s altered coping mechanisms were rendered less effective by diabetes mellitus² and other comorbidities that required persistence and ingenuity from caregivers.

Index: Ostomy Wound Manage. 2012;58(1):16–22

Abstract
  Preclinical studies have shown that release of silver by different wound dressings varies. The purpose of this in vitro study was to compare the antimicrobial activity of silver alginate (SA) and silver carboxymethylcellulose (SCM) dressings. Antimicrobial activity was tested using nine bacterial strains with log10 reduction and corrected zone of inhibition (CZOI) assays. Antimicrobial effect was visualized using confocal microscopy (CLSM). Log₁₀ reduction was comparable between both dressings for Staphylococcus aureus NCIMB 9518, Candida albicans ATCC 90028, Finegoldia magna NCTC 11804^T, and Pseudomonas aeruginosa NCTC 10662. Log₁₀ reduction was higher for SCM than SA dressing-exposed Escherichia coli (P = 0.035) and P. aeruginosa ATCC 15692 (P = 0.032), and lower for SCM than SA dressing-exposed Streptococcus pyogenes (P = 0.007), Peptoniphilus asaccharolyticus (P = 0.045), and S. aureus NCTC 8325 (P = 0.012). Both dressings were equivalent against four strains (5 to 8 days’ activity) in the CZOI assay. SA dressing silver activity lasted >24 hours longer than SCM activity when exposed to C. albicans (9 days’ activity), E. coli (7 days’ activity), F. magna (5 days’ activity), and P. asaccharolyticus (5 days’ activity), whereas the SMC exhibited greater persistence against S. pyogenes (13 days’ activity). CLSM showed complete kill of S. aureus after 20 hours for both dressings. The results of this study confirm the broad-spectrum, in vitro activity of some dressings containing ionic silver. The in vitro antimicrobial efficacy of both wound dressings was comparable, but clinical studies comparing the efficacy and effectiveness of silver-containing dressings to nonionic silver-containing dressings are needed.

Index: Ostomy Wound Management 2011;57(12):30–35

Abstract

  Pain upon negative pressure wound therapy (NPWT) dressing removal has been reported and is believed to be associated with the observation that granulation tissue grows into foam. Wound tissue damage upon removal of the foam may cause the reported pain. Calcitonin gene-related peptide (CGRP) and substance P are neuropeptides that cause inflammation and signal pain and are known to be released when tissue trauma occurs. The aim of this controlled in vivo study was to compare the expression of CGRP and substance P in the wound bed in control wounds and following NPWT and foam or gauze dressing removal. Eight pigs with two wounds each were treated with open-pore structure polyurethane foam or AMD gauze and NPWT of 0 (control) or -80 mm Hg for 72 hours. Following removal of the wound filler, the expression of CGRP and substance P was measured, using arbitrary units, in sections of biopsies from the wound bed using immunofluorescence techniques. Substance P and CGRP were more abundant in the wound edge following the removal of foam than of gauze dressings and least abundant in control wounds. The immunofluorescence staining of the wound edge for CGRP was 52 ± 3 au after the removal of gauze and 97 ± 5 au after the removal of foam (P <0.001). For substance P, the staining was 55 ± 3 au after gauze removal and 95 ± 4 au after foam removal (P <0.001). CGRP and substance P staining was primarily located to nerves and leukocytes. The increase in CGRP and substance P immunofluorescence was especially prominent in the dermis but also was seen in subcutaneous and muscle tissue. Using gauze may be one way of reducing NPWT dressing change-related pain. New wound fillers designed to optimize granulation tissue formation and minimize pain issues presumably will be developed in the near future.

Keywords: animal model, controlled study, negative pressure wound therapy, pain, dressing

Potential Conflicts of Interest: This study was supported by the Swedish Medical Research Council, Lund University Faculty of Medicine, the Swedish Government Grant for Clinical Research, Lund University Hospital Research Grants, the Swedish Medical Association, the Royal Physiographic Society in Lund, the Ake Wiberg Foundation, the Anders Otto Swärd Foundation/Ulrika Eklund Foundation, the Magn Bergvall Foundation, the Crafoord Foundation, the Anna-Lisa and Sven-Erik Nilsson Foundation, the Jeanssom Foundation, the Swedish Heart-Lung Foundation, Anna and Edvin Berger’s Foundation, the Märta Lundqvist Foundation, Lars Hierta’s Memorial Foundation, and Prospera (Forth Worth, TX).