Predicting post-injury depression and PTSD risk

Addressing the psychological effects of injury can improve health and reduce the negative outcomes of injury. Yet, in a national survey, only 7% of trauma centers incorporate routine screening for PTSD symptoms.  Click here to read further.

EpiFix for chronic wounds [MIB 139]

New:  EpiFix for chronic wounds


EpiFix (MiMedx) amniotic membrane allograft is made of dehydrated human amnion/chorion membrane tissue (dHACM). The tissue is derived from amniotic membranes donated with informed consent in the US. EpiFix is terminally sterilised to reduce virus transmission. It is promoted to enhance wound healing, reduce scar tissue formation and modulate inflammation.
EpiFix is indicated for a wide range of wounds; the scope of this briefing is chronic difficult-to-heal wounds including diabetic foot ulcers, venous leg ulcers, arterial ulcers and pressure ulcers.
The company's instructions for use recommend weekly administration. After wound cleaning and debridement in a non-infected wound, EpiFix is removed from the packaging and cut to fit the size of the wound. After EpiFix is applied, a non-adherent contact layer should be placed on top and the wound dressed as usual. EpiFix can be used alongside compression, offloading, negative pressure and hyperbaric oxygen therapy.


The innovative aspect of EpiFix is that it is an allograft of human amniotic membrane that has been processed and purified for use (using the MiMedx proprietary PURION process). This is designed to preserve bioactive components and deliver non-viable cells, multiple extracellular matrix (ECM) proteins, active growth factors, cytokines, chemokines and other specialty proteins present in amniotic tissue with the aim of helping to regenerate soft tissue.

Nutrition and hydration

These resources from NHS Improvement on using nutrition and hydration to reduce the incidence of pressure ulcers and promote good wound healing, include evidence and recommendations for assessment and action when assessing an individual’s risk of developing a pressure ulcer; five top tips to prevent pressure ulcers; and three case studies.

Chelsea and Westminster Hospital physios help develop hand therapy app

Physiotherapists at Chelsea and Westminster Hospital NHS Trust have been instrumental in developing an app to support people with hand injuries.

It provides patients with bespoke exercises prescribed by their therapist to aid recovery, according to a spokesperson for the trust, which treats more than 4,500 hand injury patients every year.

The app also contains a library of more than 80 instructional videos and audio tutorials, which patients can follow and replicate at home.

Common Paediatric Elbow Injuries

The Open Orthopaedics Journal, 11(Sup 8, M6) p1380-1393. DOI: 10.2174/1874325001711011380

Paediatric elbow injuries account for a large proportion of childrens’ fractures. Knowledge of common injuries is essential to understanding their assessment and correct management. Understanding of the ossification centres around the paediatric elbow is essential to correctly assessing and managing the common injuries that we have discussed in the review. Outcomes after these injuries are usually favourable with restoration of normal anatomy.

UHCW Research: Christopher E. Hill, Stephen Cooke

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries (IPG594)

New NICE Interventional Procedure guidance on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure in people with high spinal cord injuries. This involves implanting electrodes into the diaphragm to make it contract. This gradually strengthens the diaphragm and may eventually help the person to breathe without a ventilator.

Current evidence on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries shows that there are serious but well-recognised safety concerns. Evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.

Heel casts do not improve heel ulcers in diabetes

Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference.

Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effectiveness of using a similar approach for heel ulcers.
This NIHR-funded trial indicates that specially-moulded heel casts do not improve healing rates or pain, and were not a good use of NHS resources compared with usual care.

Uncertainty remains over the optimal approach for managing heel ulcers in people with diabetes.https://discover.dc.nihr.ac.uk/portal/article/4000781/heel-casts-do-not-improve-heel-ulcers-in-diabetes

Holoclar for treating limbal stem cell deficiency after eye burns [TA467]

Holoclar for treating limbal stem cell deficiency after eye burns

Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) is recommended as an option in people with moderate to severe limbal stem cell deficiency after eye burns, only if:

• it is only used to treat 1 eye and
• people have already had a conjunctival limbal autograft or
• there is not enough tissue for a conjunctival limbal autograft or
• it is contraindicated andthe company provides it with the discount agreed in the patient access scheme.

Head injury: assessment and early management

Updated NICE guidance on the assessment and early management of head injury.

In June 2017, we updated recommendations 1.2.8 and 1.4.12 with cross-references to related NICE guidelines, and an outdated research recommendation was deleted.

Effect of endometrial injury on reproductive outcome in assisted reproduction: An observational study

Human Reproduction. Conference: 32nd Annual Meeting of the European Society of Human Reproduction and Embryology. Finland. Conference Start: 20160703. Conference End: 20160706. 31 (pp i284), 2016. Date of Publication: July 2016.

To analyse the effect of endometrial injury before IVF or ICSI on clinical pregnancy outcome. Summary answer: Endometrial scratching performed before IVF/ICSI increased clinical pregnancy outcome in the second attempt of IVF/ICSI, unlike overall comparison.

UHCW Research: Garg N.; Harthshone G.; Ghobara T.; Rai J.; Keay S.; Agarwal R.

Potential new treatment for non-freezing cold injury: is Iloprost the way forward?

Journal of the Royal Army Medical Corps Published Online First: 23 March 2017. doi: 10.1136/jramc-2016-000672 

Non-freezing cold injury (NFCI) remains largely under-reported, and is of particular importance in the armed forces where its prevalence is greatest. Iloprost, a synthetic prostaglandin I2 analogue, has previously been used with some success in the treatment of vasospastic and freezing cold injuries, although its role in NFCI remains unclear.

The use of iloprost in the treatment of NFCI is discussed and its use in a condition which physicians consistently struggle to treat effectively is considered. Careful counselling is recommended as symptoms may be worsened.

UHCW Research: Anne-Marie Ionescu, Sarah Hutchinson, Mehtab Ahmad and Christopher Imray

Report highlights need for early intervention for diabetic foot ulcers

A report published by NHS Digital and Diabetes UK finds that early intervention is important in the management of diabetic foot disease, with people who receive expert care most quickly having the best outcomes.

It also reports that the basic framework for effective prevention and management of diabetic foot disease in England and Wales is often missing.

TopClosure Tension Relief System for wound closure

NICE medtech innovation briefing (MIB) on TopClosure Tension Relief System for wound closure.

Long term conditions scenarios: osteoporosis and wound care

NHS RightCare has published two new scenarios in its long term conditions series. The scenarios, on osteoporosis and wound care, use fictional people to examine patient journeys, comparing sub-optimal but typical scenarios against ideal pathways. The scenarios contain modelled costs of care for commissioners.

Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Abscess

New from BestBETs:

In [patients with uncomplicated skin abscesses who have undergone abscess incision and drainage], does [treatment with oral trimethoprim-sulfamethoxazole compared to placebo] [reduce treatment failure at 7 days]?

Trimethoprim-sulfamethoxazole may help with abscess cure, and will decrease abscess formation at new sites.

Utility of ultrasound in the diagnosis of shoulder dislocation

New from BestBETs

In [adult patients with clinically presumed shoulder dislocations] is [ultrasound as reliable as radiography] in [identifying shoulder dislocation]?

The use of ultrasound shows promise as a method of confirming shoulder dislocation without requiring X-ray. Although both studies had sensitivity and specificity of 100% compared with plain X-rays, only two relatively small studies were found in the literature search; further validation of these findings would be required before recommending this as standard practice.

Wearing a patch after a scratch to the eye probably makes no difference to healing

After a scratch or minor damage to the outer layer of the eye (corneal abrasion), wearing an eye patch is unlikely to reduce pain at 24 hours and might not lead to quicker healing after 24 hours. Patching the eye was compared to leaving the eye uncovered. Eye patches did not significantly affect symptoms such as eye watering, irritation, sensitivity to light or blurred vision.

From the NIHR Dissemination Centre

Tracheal Extubation of Patients With Cervical Spine Injury: A Case Report and Review of Literature

A & A case reports 2016

In patients with cervical spine injuries, emergence from anesthesia and tracheal extubation can prove as challenging to the anesthesiologist as the tracheal intubation. We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care. The case report is followed by a review of literature relating to safe extubation of patients with cervical spine injuries. Possible complications during emergence and various methods to prevent these complications are discussed.

UHCW Research: Nowicka, Aleksandra

Let’s work together to stop the pressure

NHS England is co-ordinating a new ‘Stop the Pressure’ improvement programme to build on the efforts Trusts have already made. The original programme led to a 50% reduction in pressure damage. Our relaunch will build on the tools, knowledge and skills from this as well as linking in with other pressure damage programmes. It will run across acute and community settings in collaboration with key partners in social services and care home settings.

UrgoStart for chronic wounds

New Medtech Innovation Briefing on the use of UrgoStart for chronic wounds.