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    Our research and development teams operate at a global level and generate synergies from our collective expertise and by drawing on related disciplines. We are also constantly exchanging information at an international level with independent technical institutions, key opinion leaders and multipliers in order to be able to ensure cooperation and knowledge management of the highest order. As part of this process, we also conduct extensive research, the results of which we continually present in workshops, at conferences and symposiums - either in documentation or talks given by our cooperation partners - and also publish in renowned scientific journals. This database contains a large number of these evidence-based scientific articles, most of which have been evaluated by independent assessors:

    1. Poster

      CLINICAL PATHWAY AS A TOOL FOR WOUND MANAGEMENT OF PATIENTS WITH VENOUS LEG ULCERS

      Poster presented at WUWHS 2004 08.07.2004 Paris, France

      INTRODUCTION

      Complex wounds may cause a dependence of patients on professional care for a longer period than necessary. Healthcare reflects an interest in linear continuity. Leg ulceration is tissue breakdown that occurs in already damaged skin, it is a common condition with a prevalence between 1.5 and 3 per 1000. Various studies on leg ulceration show that approximately 90% of causes for ulceration of the lower limb are of venous -, i.e. venous-lymphatic origin. As age progresses mixed venous-arterial forms become more frequent, especially in connection with diabetes mellitus. About 6% of the causes for leg ulcerations are of arterial origin, the remaining circa 4% are divided over the other groups. Leg ulcers are considered chronic, when it takes more than six weeks to close them. Most patients are managed in primary - care, community nurses spend a considerable amount of their time managing leg ulcers patients. It is recognised that the most important factor in treating venous leg ulcers is the application of effective sustained compression. A venous ulcer will fail or be slow to heal without the application of sustained graduated compression. Studies have shown a strong correlation between the duration of the ulcer and the time it takes to healing the ulcer. Large size ulcers (circumferential ulcers) were reported to take longer to heal than small ulcers (< 4cm2). Many of the bandages traditionally used to treat patients with venous leg ulceration, are ineffective due to lack of technique and practice by persons applying the bandage. For the application of short stretch bandages different application techniques are in use. A commonly used technique is the application of 2 bandages of 8- and 10 cm width, starting at the foot. The system is reapplied when clinically required at the discretion of the care giver, by the patient/family or nurse. The bandages are washed and reused up to 6 times.

       

      MATERIAL AND METHODS

      This paper gives a report of the development and validation of a clinical pathway for patients with venous leg ulcers. The evidence based clinical pathway (box I) and applicable products* (box II and III), were tested by using case ascertainment.

      The purpose of this study is to evaluate a clinical pathway, applied for patients with venous leg ulceration, looking at the performance of the compression system used and the dressings applied. Before recruitment to the study patients were assessed using a standard procedure which includes the measurement of ankle brachial pressure indices (ABPI) and Doppler, to determine whether the patient is suffering from significant peripheral arterial disease. If applicable, further diagnostics, using Duplex Sonography, phlebography and DPPG were performed. In-patients and/or out-patients at the trial centre are recruited to the study. The number of patients in this study (N = 10) was not based on a statistical consideration. Patients are treated applying the clinical pathway on an intention to treat basis, with the short stretch bandage system (Rosidal® Sys) and a wound dressing from the Suprasorb® range. The clinical Investigator sought permission of the relevant consultant for their patients and of the patient to be included in the study. A standardized questionnaire is used for this clinical evaluation. Identified patients were clinically examined to determine general condition, associated factors, wound type, stage, wound evolution, quality of life aspects, efficacy of treatment, costs efficacy (focussing costs of treatment as well as time investment of staff) etc. Clinical examination was performed, depending on wound type, upon initial assessment and at 2 week intervals. The evaluation included structured interviews on how wound management was carried out, before implementing the clinical pathway. Available outcome of the centre on the treatment of patients with venous leg ulcers was used as a baseline.

      For each individual patient, the clinical evaluation observation period was 12 weeks. The patient record form booklet was completed for one wound only. The number of patients that were withdrawn from the study, of which the ulcer had not healed were listed in full, as well as adverse incidents, whether bandage related or otherwise.

       

      RESULTS

      The interim results demonstrated an improvement of quality of care, cost savings and moreover an improved level of knowledge and communication between the clinicians involved in the care of patients with venous leg ulcers.

       

      CONCLUSIONS

      Communal knowledge and effort can be tuned to the interest of patients, institutions and commercial parties. Clinical pathways applied throughout the complete care chain, supports improvement of quality of care.

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    2. Journal article

      A small study in healing rates and symptom control using a new sheet hydrogel dressing

      Journal of wound care 2004 13(7) 297300

      OBJECTIVE

      This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa).

      METHOD

      This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study.

      RESULTS

      Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%.

      CONCLUSION

      ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels.

      PMID 15977772
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    3. Journal article

      Caring for patients with leg ulcers and an underlying vasculitic condition

      British journal of community nursing 2004 Suppl 1622

      It is not uncommon for nurses in the community to encounter patients with leg ulceration combined with rheumatic disease, particularly rheumatoid arthritis (RA). The aetiology of the leg ulcers in these cases is rarely straightforward, and the management of the ulcers is correspondingly complex. Management may be further complicated in the presence of vasculitis, an uncommon disorder in which inflammatory changes cause degradation of blood vessels. Rapid deterioration and pain are the main challenges with these cases. This article discusses the aetiology of vaculitic ulcers, and presents two case studies which were successfully managed using a new hydrogel dressing.

      PMID 15655493
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    4. Journal article

      A small study in healing rates and symptom control using a new sheet hydrogel dressing

      Journal of wound care 2004 297300

      OBJECTIVE

      This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa).

      METHOD

      This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study.

      RESULTS

      Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%.

      CONCLUSION

      ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels.

      Products Suprasorb G
      PMID 15977772
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    5. Journal article

      Effectiveness of a biocellulose wound dressing for the treatment of chronic venous leg ulcers: Results of a single center random

      Wounds 2004 16(7) 223224

      Venous ulceration, a relative common manifestation of chronic venous insufficiency and venous hypertension, is often difficult to treat. Successful treatment begins with the management of the underlying pathology and wound bed preparation. This article reports the authors' experience with a novel wound dressing produced from microbial cellulose synthesized by an acid- producing bacterium, Acetobacter xylinium. Twenty-four patients with chronic venous insufficiency and lower-leg ulceration were treated with either biocellulose wound dressing (BWD) plus a two- layer compression bandage or standard care. Standard care consisted of a nonadherent primary wound dressing plus a two-layer compression bandage. Evaluations were performed weekly to measure wound pain, nonviable tissue reduction, degree of wound granulation, and wound healing (reduction in wound size and surface area). BWD was significantly more effective than standard care for autolytic debridement (reduction in the amount of nonviable tissue [p=0.0094]). The mean number of days to >75-percent granulation was 43 days for the BWD treated group and 71 for the standard care group. Mean percent reduction in wound area was also greater for the BWD treated group at Week 6 (39% vs. 19%) and at Week 12 (74% vs. 49%). When compared to patients treated with standard care, the group treated with BWD reported less wound pain at each evaluation point. Significant differences in wound pain scores between the two treatments were noted at Week 3, 6 (p=0.039), and 8 (p=0.043).

      Products Suprasorb X
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    6. Journal article

      Bandages - where to begin

      Nurse2Nurse Magazine 2004 4(9)

      Strange as it may seem to a newly qualified nurse, bandaging was once considered important enough to warrant training and instruction (Penn 2002). Bandaging skills continue to remain essential, both for retaining wound dressings for patients with sensitive skin who are intolerant to adhesive and as a method of supporting injured joints or treatment for leg ulcers (Finnie 2002). No less important is their use in the treatment of eczema and other skin problems (Abeck 1999). This article considers commonly used bandages and techniques highlighting characteristics, indications and contraindications for their use. The author believes that general nurses should actively participate in gaining current knowledge of the precise skills of bandaging selection and appliction, and know when to seek further advice from specialists like the tissue viability nurse or vascular nurse.

      Products Rosidal K
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    7. Journal article

      Quality of life in a trial of short stretch versus four-layer bandaging in the management of chronic venous ulceration

    8. Journal article

      What to tell my patients about short-stretch bandaging

      British journal of community nursing 2004 8(3)
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    9. Journal article

      A hydrogel that may help relieve sunburn pain

      Practice Nursing 2004 15(11) 565567
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    10. Journal article

      Development and testing of a novel biosynthesized XCell for treating chronic wounds

      Surgical technology international 2004 12 2733

      Biosynthesized cellulose is produced by the bacteria, Acetobacter xylinum, and possesses unique properties not present in other biomaterials. The material is formed during fermentation having a multi-layered structure composed of fine, nonwoven, cellulose hydrophilic fibers. This structure allows biosynthesized cellulose to have a high-fluid capacity, superior strength, and biocompatibility, which makes it suitable for topical and implantable biomedical applications. Initial product development of biosynthesized cellulose has focused on advanced wound-care applications. The product, XCell (Xylos Corporation, Langhorne, PA, USA), has been bioengineered to have the ability to both donate and absorb moisture, depending on the wound environment. Comparative bench testing has shown that XCell is the only wound dressing with this unique dual-fluid-handling capability. The product has been studied thoroughly using animal models and proved to be safe and biocompatible. Human clinical testing has demonstrated its effectiveness in providing a moist environment, essential to treating hard-to-heal chronic wounds. The major clinical benefits of the product include: 1) help in removal of non-viable tissue and promotion of autolytic debridement, which results in increased granulation tissue; 2) cleansing of wound margins that leads to epithelial migration and reduction of wound size; and 3) healing of various types of chronic wounds.

      Products Suprasorb X
      PMID 15455308
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