The use of PICO single-use negative pressure wound therapy in the community settings.

The prevalence and incidence of wounds is predicted to rise due to an ageing population, that is also likely to have an increasing number of comorbidities (Dowsett et al, 2017). This trend will invariably result in increased costs to the NHS. The estimated annual cost of wound management in 2017/2018 was £8.

Clinical negligence claims for pressure injuries from the perspective of a tissue viability medico-legal nurse expert.

Clinical negligence claims for pressure injuries against the NHS continue to rise annually. This article will discuss the number of claims and financial costs to the NHS, together with the legal processes involved. Issues such as duty of care, breach of duty and harm and how these are interpreted in law will be explained, together with advice on how to avoid a potential negligence claim in the future.

Legal implications of pressure injuries: experience of a tissue viability nurse expert.

NHS Resolution manages the Clinical Negligence Scheme for Trusts, and aims to reduce the cost of litigation in terms of clinical negligence claims. To achieve this, potential clinical negligence claims are screened to assess whether to defend the claim or to provide an out-of-court settlement. Nurse experts from all nursing specialties are engaged to review all documentation and patient records to offer an opinion on the viability of a claim.

Managing exudate and maceration in venous leg ulceration within the acute health setting.

Exudate has beneficial effects in normal wound healing but detrimental consequences for chronic wounds. Practitioners need to identify and treat its cause, and manage the exudate and prevent if from damaging periwound skin. Management involves dressings of the most appropriate absorbency and other products, and avoiding maceration of periwound skin; compression therapy is the gold standard treatment for treating oedema and venous leg ulceration.

The Inverse Relationship between the Microstructural Variability of Amygdala-Prefrontal Pathways and Trait Anxiety Is Moderated by Sex.

Anxiety impacts the quality of everyday life and may facilitate the development of affective disorders, possibly through concurrent alterations in neural circuitry. Findings from multimodal neuroimaging studies suggest that trait-anxious individuals may have a reduced capacity for efficient communication between the amygdala and the ventral prefrontal cortex (vPFC). A diffusion-weighted imaging protocol with 61 directions was used to identify lateral and medial amygdala-vPFC white matter pathways.

The assessment and treatment of wound pain.

This article is the third in a series on wound management. Poor pain management leads to distress and can impede the healing process. This article describes the different types of pain and the psychological aspects of pain that should be taken into account when deciding on a wound-management strategy.

The principles of holistic wound assessment.

This article is the second in a series designed to enhance nurses' knowledge of wound management. It highlights the importance of assessing patients holistically, and provides an overview of the key factors that should be considered when assessing a wound. A well-designed template enables nurses to carry out a comprehensive assessment that ensures accurate documentation to monitor wound healing.

Phases of the wound healing process.

This is the first in a six-part series on wound management. It describes the stages of the wound healing process and explains how they relate to nursing practice. Nurses need to know how to recognise and understand the different phases so they can identify whether wounds are healing normally and apply the appropriate treatments to remove the barriers to healing.

Canadian Triage and Acuity Scale: testing the mental health categories.

Purpose: The study tested the inter-rater reliability and accuracy of triage nurses' assignment of urgency ratings for mental health patient scenarios based on the 2008 Canadian Triage and Acuity Scale (CTAS) guidelines, using a standardized triage tool. The influence of triage experience, educational preparation, and comfort level with mental health presentations on the accuracy of urgency ratings was also explored.

Methods: Study participants assigned urgency ratings to 20 mental health patient scenarios in randomized order using the CTAS.

Strategies to reduce or eliminate wound pain.

Wound pain is often underestimated and poorly managed. This article explains the different types of pain and how to assess wound pain, and gives practical advice on how to manage or minimise the pain experienced by patients with wounds.

Drawtex: breaking the vicious circle of cellular and molecular imbalances.

Uncontrolled cellular and molecular activity in the inflammatory phase of healing will determine whether a wound becomes chronic. Assessment and interventions designed to remove the barriers to healing are essential in order to break the vicious cycle and to kick-start healing in chronic wounds. This product focus gives an overview of the inflammatory phase of the wound healing continuum; discusses how the imbalance of matrix metalloproteinases/tissue inhibitors of matrix metalloproteinases occurs; how this imbalance manifests itself clinically within the wound; and what health professionals can do in order to tip the balance in favour of healing.

Encouraging patients to self-care - the preliminary development and validation of the VeLUSET©, a self-efficacy tool for venous leg ulcer patients, aged 60 years and over.

Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but evidence suggests that many find these difficult to perform. Bandura's self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions.

The role of debridement in the healing process.

Guidance on wound debridement has been updated. This article discusses the most commonly used debridement methods recommended in the guidance and gives an overview of new technology. It provides practice points on how to debride a wound successfully.

Implications of patient shared decision-making on wound care.

This article discusses the Government's drive to promote health professional and patient partnership working within healthcare, with a focus on enhancing wellbeing and how this relates to tissue viability. The literature has demonstrated how wounds impact negatively on a patient's sense of wellbeing. Assessing the impact of a wound on patient wellbeing is an essential as part of an holistic assessment process, but is even more important when the wound is chronic or recalcitrant to treatment.

Reducing uncertainty in triaging mental health presentations: examining triage decision-making.

Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses' decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage.

The structural and functional connectivity of the amygdala: from normal emotion to pathological anxiety.

The dynamic interactions between the amygdala and the medial prefrontal cortex (mPFC) are usefully conceptualized as a circuit that both allows us to react automatically to biologically relevant predictive stimuli as well as regulate these reactions when the situation calls for it. In this review, we will begin by discussing the role of this amygdala-mPFC circuitry in the conditioning and extinction of aversive learning in animals. We will then relate these data to emotional regulation paradigms in humans.

Chronic leg ulceration in the community: changing the focus.

Compression therapy is considered the gold standard for healing chronic venous leg ulceration, and impressive healing rates are achievable for many patients. Unfortunately, this condition is chronic, characterized by frequent recurrences and, for some patients, ulcer healing may never occur. Within community services, commissioners of nursing services tend to focus on complete ulcer healing within a defined timescale as quality indicators.

Dopamine enhances expectation of pleasure in humans.

Human action is strongly influenced by expectations of pleasure. Making decisions, ranging from which products to buy to which job offer to accept, requires an estimation of how good (or bad) the likely outcomes will make us feel [1]. Yet, little is known about the biological basis of subjective estimations of future hedonic reactions.

Does social support impact on venous ulcer healing or recurrence?

Much of the leg ulcer literature focuses on clinical assessment and management of chronic venous leg ulceration in order to achieve healing. Chronic venous leg ulceration, however, should be classed as a chronic or long-term condition, defined as a condition,'that is currently not curable and therefore can only be managed', although it is not generally acknowledged as such. There is an extensive body of literature which focuses on the psychosocial issues that impact negatively on the quality of life of patients with long-term conditions, such as diabetes or arthritis.

Cholesterol screening in an at-risk pediatric population.

Elevation of low-density lipoprotein (LDL) cholesterol is a recognized risk factor for premature atherosclerosis and such elevations have their antecedents in the pediatric population. This study evaluated the frequency of elevated LDL cholesterol in children and adolescents (8-18 years) in whom one parent had a history of premature ischemic heart disease (<55 years). Patients had a fasting lipid profile performed and results were classified as normal, borderline/high, or high in accordance with the American Academy of Pediatrics (AAP) guidelines.