Biomedical subjects
Publications and source records attributed to C Williams.
Profore four-layer bandage system (Smith & Nephew) is a multi-layer compression system for the treatment of venous leg ulcers. Venous leg ulcers have long been an enormous drain on the NHS, particularly within the community sector. Compression therapy is now known to be the mainstay of treatment for such ulcers. The Profore four-layer bandage system is simple to use and provides the correct compression to effect faster healing.
Chronic leg ulcers often present as a chronic open wound with surrounding eczematous skin. Paste bandages are widely used to treat such ulcers and their associated skin conditions, but can often lead to hypersensitivity reactions leading to contact dermatitis. This product focus features Steripaste (Seton Healthcare) which is a new preservative-free, medicated paste bandage that is available on the Drug Tariff for use in the community sector.
Tegasorb advanced formulation hydrocolloid dressing from 3M Healthcare can be used on a variety of wounds, e.g. leg ulcers and donor sites. It encourages a moist wound-healing environment and can be used in all stages of wound healing, from black necrotic tissue to the epithelializing wound. Tegasorb is a well-established hydrocolloid dressing that has recently been relaunched as an advanced formulation.
Hydrogels have been used for some time in wound management to maintain a moist wound interface and to aid the debridement of slough and necrotic tissue. Granugel (ConvaTec) is a combination of both hydrogel and hydrocolloid, which has been shown to be a safe and effective dressing that is also cost-effective.
The management of venous leg ulcers is an important issue for many health-care professionals. If treatment is to be successful, it is vital that clinicians understand the physiology and disease processes of the venous system in general, and of venous ulceration in particular. Part one of this two-part article presents an outline of the normal physiology of the venous system in the lower limb followed by a brief history of venous leg ulcers and an in-depth analysis of the way in which venous disease can lead to ulceration. The analysis compares traditional theories of leg ulcer development with current hypotheses. Part two will look at the treatment of venous ulcers and associated nursing implications.
This article, the second in a two-part series, discusses the treatment options available for venous leg ulceration, and their implications for the nursing profession. Current views on the use of compression therapy, drug therapy, growth factors and surgery are examined. Successful management of patients with venous leg ulcers depends on thorough assessment, effective treatment and prevention of recurrence. Many health-care professionals lack the necessary knowledge, understanding and training to treat such patients effectively. Improvements in the care of venous leg ulcers will lead to significant reductions in treatment costs.
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Many patients can be sitting in a chair for between 3 and 14 hours each day, consequently the type of cushion they are sitting on is of the utmost importance. These patients are often at high risk of developing pressure sores--possibly more so than bed-bound patients. Vicair, whose UK distributor is Gerald Simonds Healthcare, has developed two types of pressure-reducing cushions: the Vicair Academy and Liberty Fluid-Air. These cushions offer pressure reduction in a system that is user-friendly and particularly lightweight. This product focus highlights the problems associated with seating and explains how the Vicair range of cushions attempts to address them.
It has been known for many years that silver has antimicrobial properties. Arglaes is a film dressing that provides a continuous and controlled release of silver ions and is produced by Maersk Medical. The name is derived from argentum, which is Latin for silver, and Ag, the chemical symbol for silver. Since the emergence of resistant organisms, topical antibiotics are best avoided. Arglaes has been developed in the light of this and appears to control the bacteria in wounds and prevent bacterial contamination. Arglaes also provides a moist environment for the healing process and is suitable for many wound types.
There are many types of support surfaces available. Selection of a suitable support surface for an individual patient is best done by first identifying the patient's risk of pressure sore development. Transfoam was originally developed in 1990 and is designed for the medium-risk patient. The new design transfoam Wave combines increased comfort with lower interface pressures, to provide another mattress in the Transfoam family. This product focus examines the original Transfoam mattress produced by Karomed and looks at the design and results of early testing of the new Transfoam Wave.
An increasing number of hydrogel dressings have become available to the practitioner over the last few years. Sterigel (Seton Healthcare) is the latest to be launched. This dressing is able to donate large quantities of fluid and thereby speed up the debridement of slough and necrotic tissue.
Skin often becomes vulnerable in incontinent patients or following the use of aggressive adhesive tapes and dressings. Until recently the only products available for use on such skin have been ointments, creams and alcohol-based products. 3M Health Care has launched a range of no sting barrier film applicators that provide skin protection in many scenarios, but in a product that does not sting or cause pain on application.
Pressure area care for patients who have undergone a hip replacement is extremely difficult as patients' mobility tends to be restricted because of fear of dislocation. Orthopaedic surgeons influence the positional changes and techniques utilized by nurses in the postoperative period. This article reviews factors that prevent early rehabilitation and highlights methods of pressure relief for this patient group. Alternating-pressure mattresses are a main source of pressure-relieving equipment. A pilot study using the Nimbus II mattress was carried out to establish the role of alternating-pressure mattresses in the postoperative management of patients undergoing elective/emergency hip replacement surgery. None of the patients in the pilot study suffered prosthetic dislocation and 87% did not develop pressure sores. Three patients did develop a grade 2 pressure sore postoperatively. The results reinforce the use of alternating-pressure mattresses in the postoperative management of patients undergoing hip replacement surgery.
Alginates have been used in wound care for many years. In recent years alginate dressings have developed to provide an extremely cost-effective way of managing wounds with a moderate to high level of exudate. The dressing gel has traditionally been either soft or firm on removal, but with new technology softness and fast gelling may now be combined with high integrity in a single product. An example of such a product is Melgisorb from Mölnlycke Health Care (the makers of Mepore). Melgisorb is just one dressing in their range of chronic wound care products.
Research has demonstrated that wounds heal faster in a moist environment. Film dressings are used to promote a moist environment. Mefilm is part of the Mölnlycke Health Care chronic wound care system and is a gentle, adherent polyurethane dressing. This product focus discusses the development of the semi-permeable film dressing, Mefilm, examining its uses, application and removal.
Hydrocolloid dressings were first used in wound management in the 1960s. They provide the optimal environment for wound healing, i.e. a moist environment, constant wound temperature and infrequent dressing changes, and can be used on wounds in various stages of healing. As a result they are a popular treatment option for health professionals in both the community and hospital settings. This article describes the properties of Hydrocoll--a new and exciting range of hydrocolloid dressings from Paul Hartmann Ltd--which was launched in the UK in January 1998 and became available on the Drug Tariff in June 1998.
Pressure sores are believed to occur as a result of two pressures, external pressure leading to occlusion, and disruptive shearing forces causing endothelial damage to the micro circulation. One of the main principles, therefore, of pressure sore prevention is relief or reduction of pressure. Scandinavian Mobility produces a range of systems--therapeutic cushions, specialist cushions and products, and mattresses--that can reduce the pressure, reportedly achieving interface pressures of 21-28 mmHg. These systems have been shown to be cost-effective in the clinical setting and provide pressure relief in low-, medium- and high risk patients.
Lymphoedema is a chronic condition which, if untreated, becomes progressively worse. It cannot be cured, but it can be monitored, treated and maintained to give the patient a relatively normal quality of life (Barrett, 1997). This product focus looks at lymphoedema, its treatment and the role of a compression system from Vernon-Carus.