Displaying publications 1 - 20 of 31 in total

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  1. Hussan F, Teoh SL, Muhamad N, Mazlan M, Latiff AA
    J Wound Care, 2014 Aug;23(8):400, 402, 404-7.
    PMID: 25139598 DOI: 10.12968/jowc.2014.23.8.400
    Transforming growth factor-β (TGF-β) plays an important role in wound healing. Delayed wound healing is a consequence of diabetes, leading to high morbidity and poor quality of life. Momordica charantia (MC) fruit possesses anti-diabetic and wound healing properties. This study aimed to explore the changes in TGF-β expression in diabetic wounds treated with topical MC fruit extract.
  2. Mustafah NM, Chung TY
    J Wound Care, 2014 Feb;23(2 Suppl):S10-2.
    PMID: 24526167
    Overgranulation (also commonly known as hypergranulation) is a common problem in chronic wound management. We describe a case involving a 57-year-old lady with a chronic diabetic foot ulcer, complicated with overgranulation for the past year. She was administered with various treatments, including hydrocortisone 1% cream and hydrofiber, which proved ineffective and further delayed the healing process of her ulcer. We then decided to use crushed Papase tablets applied to her ulcer after a normal saline dressing and prior to an application of secondary dressing. The patient was instructed clearly on the dressing technique to be performed daily at home and was monitored weekly in a foot care clinic. The overgranulation resolved within 5 weeks and the patient continues recieving care to promote epithelialisation.
  3. Nair HKR, Chong SS, Othman AM
    J Wound Care, 2020 Apr 01;29(Sup4):S44-S48.
    PMID: 32279612 DOI: 10.12968/jowc.2020.29.Sup4.S44
    OBJECTIVE: To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment.

    METHOD: Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test.

    RESULTS: A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%.

    CONCLUSION: Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.

  4. Nair H, Venkateshwaran N, Seetharaman S S, Deng W, Uthaipaisanwong A, Galea E
    J Wound Care, 2021 Apr 01;30(Sup4):S42-S52.
    PMID: 33856929 DOI: 10.12968/jowc.2021.30.Sup4.S42
    OBJECTIVE: Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers.

    METHOD: A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings.

    RESULTS: A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition.

    CONCLUSION: All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.

  5. Shaharudin A, Aziz Z
    J Wound Care, 2016 Oct 02;25(10):585-592.
    PMID: 27681589 DOI: 10.12968/jowc.2016.25.10.585
    OBJECTIVE: Hyaluronic acid (HA) and its derivatives are used for chronic wounds, but evidence of their effectiveness remains unclear. The aim of this study was to provide more updated evidence for the effectiveness of HA (or its derivatives) compared with placebo or other agents for promoting healing in chronic wounds.
    METHOD: The Cochrane Central Register of Controlled Trials, MEDLINE via Ovid Online, CINAHL and the EMBASE via EBSCO host databases were searched. Drug companies and experts in wounds were also contacted. Randomised controlled trials of HA (or its derivatives) compared with control were eligible for inclusion.
    RESULTS: We identified nine randomised controlled trials involving 865 participants with chronic wounds were included in the review. The reporting for mixed arterial and venous ulcers seems to be better quality than that for venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). Studies provided little evidence regarding the claimed effects of HA or its derivaties on healing of chronic wounds. However, there is some evidence on their effectiveness for reducing pain intensity for mixed arterial and venous ulcers, which involved 255 patients (MD=-6.78 [95% CI: -11.10 to -2.46]).
    CONCLUSION: Evidence to guide decisions regarding the use of HA or its derivatives to promote wound healing is still limited. More good-quality randomised controlled trials are warranted.
    KEYWORDS: assessment bias; chronic ulcers; hyaluronan; meta-analysis
  6. Ousey K, Chadwick P, Jawien A, Tariq G, Nair HKR, Lázaro-Martínez JL, et al.
    J Wound Care, 2018 05 01;27(Sup5):S1-S52.
    PMID: 29738280 DOI: 10.12968/jowc.2018.27.Sup5.S1
  7. Nair HKR
    J Wound Care, 2018 05 02;27(5):296-306.
    PMID: 29738296 DOI: 10.12968/jowc.2018.27.5.296
    OBJECTIVE: The primary aim is to assess the efficacy of microcurrent, a form of electrical stimulation, as an adjunct therapy in accelerating healing in chronic wounds by reducing wound size and pain level. The secondary aim is to assess the qualitative changes in these parameters: inflammatory symptoms, vasodilation, sleep quality, gait and frequency of bowel movement.

    METHOD: Eligible patients with chronic wounds were enrolled between March and June 2016, from the Wound Care Unit, Hospital Kuala Lumpur in this consecutive case series. Standard wound care was performed with microcurrent as an adjunct therapy. Each patient was treated with an anti-inflammatory frequency, followed by a vasodilation frequency, while having their wounds cleansed during each dressing change. Patients were loaned a home-microcurrent device to treat themselves three times daily using a tissue repair frequency for four weeks.

    RESULTS: A total of 100 patients with chronic wounds, such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers, were recruited. During the four-week treatment period, all patients had a reduction in wound size, with 16 having complete wound closure. All 89 of the 100 patients who complained of pain, associated with their wound, experienced reduced pain scores, with 11 being pain-free at the end of the four-week period. There was significant reduction (p<0.001) in both mean pain score and mean wound area during the treatment period, as well as improvements in other parameters, such as reduction in inflammatory symptoms (leg swelling, foot stiffness), increased vasodilation (skin discolouration, leg heaviness, early morning erection, sensation), improvement in sleep quality, gait, and frequency of bowel movement. No adverse events were reported.

    CONCLUSION: The results of this study show there was significant reduction in wound area and pain score during the treatment period. The ease of use of microcurrent devices would advocate its use in accelerating wound healing.

  8. Tariq G, Alvarez HP, Nair HKR, Cordero GL
    J Wound Care, 2018 Oct 01;27(Sup10):S39-S41.
    PMID: 30307814 DOI: 10.12968/jowc.2018.27.Sup10.S39
  9. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S32-S36.
    PMID: 30207850 DOI: 10.12968/jowc.2018.27.Sup9a.S32
    OBJECTIVE: To study the effectiveness of nano-colloidal silver and chitosan bioactive wound dressings in the treatment of diabetic foot ulcers (DFU).

    METHOD: Patients with DFUs were selected randomly. Wound size, appearance and presence of infection were recorded at each dressing change.

    RESULTS: We assessed five patients in this case series. The use of both nano-colloidal silver and chitosan biopolymer dressings aided wound healing. The patients did not require surgical debridement or amputation. All five cases in this study had a slow healing rate at presentation.

    CONCLUSION: Applications of nano-colloidal silver in conjunction with chitosan bioactive as primary dressings in managing DFUs cases are safe and help increase wound healing rates, thus, leading to significant cost savings in the hospital setting.

  10. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S12-S19.
    PMID: 30207849 DOI: 10.12968/jowc.2018.27.Sup9a.S12
    OBJECTIVE: The primary aim was to determine the productivity increase using digital imagery for better documentation and analysis. A case series was done in a specialised care centre with patients managed with advanced dressings and using state-of-the-art smartphone technology for documentation to save costs and time.

    METHOD: Wounds were cleansed and debrided before using the application to photograph, document, measure and analyse the wounds. The smartphone app was oriented parallel to the plane of the wound, where possible, to obtain accurate measurements. A longitudinal study report was generated for each wound and showed the progress of the wound healing until the wound was closed.

    RESULTS: A sample size of 60 patients consisting of wounds from different locations, and a total of 203 measurements and analyses were conducted over a period of seven months. The wound monitoring app proved to be effective for wound monitoring and required less than two hours' training. A report summary of wounds recorded could also be generated automatically through the dashboard. All 60 patients' cases were automatically recorded, measured and presented into reports for use in clinical analysis. There was a significant time savings (27 hours per day for a specialised care centre with 10 nurses) increase over manual wound documentation and measuring methods.

    CONCLUSION: The app provided a non-contact, easy to use, reliable and accurate smart wound management solution for clinicians and physicians to track wound healing in patients. The app could also be used by patients and caregivers for home monitoring of their wounds.

  11. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S37-S40.
    PMID: 30207848 DOI: 10.12968/jowc.2018.27.Sup9a.S37
    BACKGROUND: Cases of venous leg ulcers (VLU) are expected to rise due to the rapidly ageing population in Malaysia. Central to the management of these wounds is compression therapy together with an appropriate wound dressing. Pain and discomfort during dressing changes are common in these patients. Polyurethane foam dressings with SMARTPORE technology (micropore dressing; Mundipharma) facilitate vertical absorption of exudate to reduce risks of wound and periwound area maceration. They support easy dressing removal with less pain and trauma to the wound bed. Thus, the micropore dressing was chosen as a viable treatment option in these cases.

    CASES: Case 1, a 74-year-old diabetic female was treated for bilateral VLUs with micropore dressing for several months, which she noted to be painless and convenient. Case 2, a 49-year-old housewife with a solitary VLU was treated with micropore dressing, leading to good treatment results and high satisfaction.

    CONCLUSION: VLUs managed by the micropore dressing resulted in reduced pain and ease of use during dressing changes, as well as noticeable reduction in wound and periwound area maceration. The use of this type of dressing in these cases shows encouraging results and provides a desirable management option. More robust clinical studies are necessary to establish this.

  12. Kee KK, Nair HKR, Yuen NP
    J Wound Care, 2019 Jan 01;28(Sup1):S4-S13.
    PMID: 30724120 DOI: 10.12968/jowc.2019.28.Sup1.S4
    OBJECTIVE:: Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU).

    METHOD:: The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic.

    RESULTS:: Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05).

    CONCLUSION:: Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.

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