| 1. |
- Gefen, Amit, et al.
(författare)
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Fluid handling by foam wound dressings : From engineering theory to advanced laboratory performance evaluations
- 2024
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 21:2
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Forskningsöversikt (refereegranskat)abstract
- This article describes the contemporary bioengineering theory and practice of evaluating the fluid handling performance of foam-based dressings, with focus on the important and clinically relevant engineering structure-function relationships and on advanced laboratory testing methods for pre-clinical quantitative assessments of this common type of wound dressings. The effects of key wound dressing material-related and treatment-related physical factors on the absorbency and overall fluid handling of foam-based dressings are thoroughly and quantitively analysed. Discussions include exudate viscosity and temperature, action of mechanical forces and the dressing microstructure and associated interactions. Based on this comprehensive review, we propose a newly developed testing method, experimental metrics and clinical benchmarks that are clinically relevant and can set the standard for robust fluid handling performance evaluations. The purpose of this evaluative framework is to translate the physical characteristics and performance determinants of a foam dressing into achievable best clinical outcomes. These guiding principles are key to distinguishing desirable properties of a dressing that contribute to optimal performance in clinical settings.
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| 2. |
- Gefen, Amit, et al.
(författare)
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How should clinical wound care and management translate to effective engineering standard testing requirements from foam dressings? Mapping the existing gaps and needs
- 2023
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Ingår i: Advances in wound care. - : Mary Ann Liebert. - 2162-1918 .- 2162-1934. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- SIGNIFICANCE: Wounds of all types remain one of the most important, expensive and common medical problems, e.g., up to approximately two-thirds of the work time of community nurses is spent on wound management. Many wounds are treated by means of dressings. The materials used in a dressing, their microarchitecture and how they are composed and constructed form the basis for the laboratory and clinical performances of any advanced dressing. Recent Advances: The established structure-function principle in material science is reviewed and analyzed in this article in the context of wound dressings. This principle states that the microstructure determines the physical, mechanical, and fluid transport and handling properties, all of which are critically important for, and relevant to the adequate performances of wound dressings.CRITICAL ISSUES: According to the above principle, once the clinical requirements for wound care and management are defined for a given wound type and etiology, it should be theoretically possible to translate clinically-relevant characteristics of dressings into physical test designs resulting specific metrics of materials, mechanical, and fluid transport and handling properties, all of which should be determined to meet the clinical objectives and be measurable through standardized bench testing.FUTURE DIRECTIONS: This multidisciplinary review article, written by an International Wound Dressing Technology Expert Panel, discusses the translation of clinical wound care and management into effective, basic engineering standard testing requirements from wound dressings with respect to material types, microarchitecture and properties, to achieve the desirable performance in supporting healing and improving the quality of life of patients.
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| 3. |
- Grimes, Poppy, et al.
(författare)
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UNVEILING GENETIC ARCHITECTURES FOR STRATIFYING TRAJECTORIES OF ADOLESCENT DEPRESSION
- 2023
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Ingår i: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 75:Suppl. 1, s. S127-S127
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adolescent-onset depression is characterised by high levels of inter-individual variability and genetic heritability. Investigating the genetic factors that underlie trajectories of depression is crucial to enhancing mechanistic understanding of the onset, persistence and severity of adolescent depression. However, predicting trajectories from complex and heterogeneous genetic architectures in psychopathology poses challenges due to the high genetic correlation among traits. It remains unclear whether multi-trait models provide a superior prediction of depression trajectories compared to univariate models focused solely on depression. Addressing this question is important for effective stratification and targeted treatments.Methods: To validate depression trajectories during adolescence, we conducted growth mixture modelling in two longitudinal cohorts (ABCD and ALSPAC; total N=20,509). We then computed polygenic risk scores for seven traits: major depressive disorder (MDD), anxiety, neuroticism, schizophrenia, bipolar disorder, attention-deficit-hyperactivity disorder (ADHD), and autism for participants with European ancestry. We also generated MDD scores for individuals of African, East Asian, and Hispanic ancestries in ABCD. Using genomic structural equation modelling, we compared three multi-trait factor models (common, correlated, hierarchical) to assess the relationships among the seven traits. To generate multi-trait risk scores from these models in our target cohorts, we conducted multivariate genome-wide association analysis to determine the effects of single nucleotide polymorphisms on genetic latent p-factors. Finally, we examined the association between all polygenic risk scores for univariate traits and multi-trait models with depression trajectories.Results: Four distinct trajectories were replicated across two cohorts with partial age-range overlap encompassing adolescents from two generations. Trajectories included stable low, adolescent acute, increasing and decreasing. The hierarchical factor model was the best fit for multi-trait genetic information and was most predictive of adolescent acute trajectories (odds ratio [OR], 1.46; 95% CI, 1.27-1.68), with increasing and decreasing showing comparable risk (OR, 1.32; 95% CI, 1.16-1.50). Multi-trait models showed a similar genetic risk for depression trajectory as MDD-only risk across trajectories. Anxiety was associated with the adolescent acute trajectories (OR, 1.27; 95% CI, 1.10-1.45). Psychotic conditions were associated with later-onset depression patterns and ADHD with earlier-onset, aligning with the developmental timelines of these respective conditions.Discussion: The investigated genetic traits collectively contribute to diverse longitudinal patterns of depression, varying in severity, onset, and duration. A hierarchical factor model of multivariate genetic psychopathology demonstrated a comparable prediction of genetic risk to univariate depression scores for stratifying longitudinal depression in adolescence. It is important to acknowledge the genetic influence of multiple conditions on depression outcomes, particularly at different stages of vulnerability. Taking into account detailed and integrated genetic information will be valuable in effectively stratifying trajectories across adolescence and mental health conditions.
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| 4. |
- Grimes, Poppy Z., et al.
(författare)
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Genetic Architectures of Adolescent Depression Trajectories in 2 Longitudinal Population Cohorts
- 2024
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Ingår i: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X.
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Adolescent depression is characterized by diverse symptom trajectories over time and has a strong genetic influence. Research has determined genetic overlap between depression and other psychiatric conditions; investigating the shared genetic architecture of heterogeneous depression trajectories is crucial for understanding disease etiology, prediction, and early intervention.OBJECTIVE: To investigate univariate and multivariate genetic risk for adolescent depression trajectories and assess generalizability across ancestries.DESIGN, SETTING, AND PARTICIPANTS: This cohort study entailed longitudinal growth modeling followed by polygenic risk score (PRS) association testing for individual and multitrait genetic models. Two longitudinal cohorts from the US and UK were used: the Adolescent Brain and Cognitive Development (ABCD; N = 11 876) study and the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 8787) study. Included were adolescents with genetic information and depression measures at up to 8 and 4 occasions, respectively. Study data were analyzed January to July 2023.MAIN OUTCOMES AND MEASURES: Trajectories were derived from growth mixture modeling of longitudinal depression symptoms. PRSs were computed for depression, anxiety, neuroticism, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, and autism in European ancestry. Genomic structural equation modeling was used to build multitrait genetic models of psychopathology followed by multitrait PRS. Depression PRSs were computed in African, East Asian, and Hispanic ancestries in the ABCD cohort only. Association testing was performed between all PRSs and trajectories for both cohorts.RESULTS: A total sample size of 14 112 adolescents (at baseline: mean [SD] age, 10.5 [0.5] years; 7269 male sex [52%]) from both cohorts were included in this analysis. Distinct depression trajectories (stable low, adolescent persistent, increasing, and decreasing) were replicated in the ALSPAC cohort (6096 participants; 3091 female [51%]) and ABCD cohort (8016 participants; 4274 male [53%]) between ages 10 and 17 years. Most univariate PRSs showed significant uniform associations with persistent trajectories, but fewer were significantly associated with intermediate (increasing and decreasing) trajectories. Multitrait PRSs-derived from a hierarchical factor model-showed the strongest associations for persistent trajectories (ABCD cohort: OR, 1.46; 95% CI, 1.26-1.68; ALSPAC cohort: OR, 1.34; 95% CI, 1.20-1.49), surpassing the effect size of univariate PRS in both cohorts. Multitrait PRSs were associated with intermediate trajectories but to a lesser extent (ABCD cohort: hierarchical increasing, OR, 1.27; 95% CI, 1.13-1.43; decreasing, OR, 1.23; 95% CI, 1.09-1.40; ALSPAC cohort: hierarchical increasing, OR, 1.16; 95% CI, 1.04-1.28; decreasing, OR, 1.32; 95% CI, 1.18-1.47). Transancestral genetic risk for depression showed no evidence for association with trajectories.CONCLUSIONS AND RELEVANCE: Results of this cohort study revealed a high multitrait genetic loading of persistent symptom trajectories, consistent across traits and cohorts. Variability in univariate genetic association with intermediate trajectories may stem from environmental factors. Multitrait genetics may strengthen depression prediction models, but more diverse data are needed for generalizability.
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| 5. |
- Raepsaet, Charlotte, et al.
(författare)
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Clinical research on the use of bordered foam dressings in the treatment of complex wounds : A systematic review of reported outcomes and applied measurement instruments
- 2022
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Ingår i: Journal of tissue viability. - : Elsevier. - 0965-206X. ; 31:3, s. 514-522
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: The aim of this review article was to identify reported outcomes and measurement instruments used in clinical research on bordered foam dressings in the treatment of complex wounds.METHODS: MEDLINE (PubMed interface), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and The Cochrane Library were systematically searched using a combination of key terms including; wounds, bordered foam dressing, and treatment. Studies were included if they (1) targeted an adult population, (2) addressed the treatment of complex wounds with a bordered foam dressing as the primary wound dressing, (3) were retrieved from original research, and (4) were published between 2000 and 2022. There were no restrictions on language or study design. Studies that focused primarily on the prevention of complex wounds were excluded. Data extraction included outcome domains, outcomes, instruments, time points, and outcome measures. The OMERACT Filter 2.0 was used as a conceptual framework for the extraction of outcomes.RESULTS: A total of 24 outcome domains and 82 outcomes were identified. The outcomes were categorised into five core areas: (1) impact on life, (2) dressing performance, (3) pathophysiological manifestations, (4) resource use, and (5) adverse events. Thirtynine outcomes (47.0%) were measured at more than one time point. The most frequently reported time point was 'at the end of treatment' (62.7%). Outcomes were measured using self-report instruments, clinical observations, and bio-physiological instruments.CONCLUSION: This systematic review identified reported outcomes and measurement instruments in research on bordered foam dressings in the treatment of complex wounds. The variety and lack of consistency in terms of instruments, time points and outcome measurements made it difficult to compare data directly across different reported studies. A solution to the variety in outcome reporting across studies in complex wound care, and moreover for the treatment with bordered foam dressings, is the development of a Core Outcome Set (COS). The outcomes in this review article will inform the next steps of developing a COS, where patients, clinicians and researchers will be involved to decide on the final outcomes included in a COS for the treatment of complex wounds with bordered foam dressings.
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| 6. |
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| 7. |
- Raepsaet, Charlotte, et al.
(författare)
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The development of a core outcome set for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds
- 2023
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Ingår i: Journal of tissue viability. - : Elsevier. - 0965-206X .- 1876-4746. ; 32:3, s. 430-436
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this project was to develop a core outcome set (COS) for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds.METHODS: The research project followed the Core Outcome Measures in Effectiveness Trials (COMET) initiative and consisted of two phases. The first phase prepared the background and process, while the second phase had three steps: outcome list generation via systematic review and qualitative study, Delphi consensus study, and consensus meeting. The study has been registered in the Core Outcome Measures in Effectiveness Trials database.RESULTS: The systematic review resulted in 82 outcomes and 20 additional outcomes were obtained during the interviews. After refinement, 111 panellists from 23 countries rated a list of 51 outcomes. In the following consensus meeting, six outcomes were prioritized to be included in the core outcome set. After the consensus meeting, a patient-reported outcome was added to the core outcome set.CONCLUSION: The COS for evaluating the effectiveness of bordered foam dressings in treating complex wounds includes 7 outcomes: "ability to stay in place", "leakage", "pain", "dressing related periwound skin changes", "change in wound size over time", and "overall satisfaction". These identified outcomes are correlated with contemporary bioengineering testing and evaluation methods for dressing performance, which underpins the need for a close multidisciplinary collaboration to advance the field of wound dressings. The outcome 'overall satisfaction' reflects the impact of complex wounds and their treatment on a patient's daily life. The use of these outcomes is recommended to improve data synthesis and promote evidence-based practice. Future developments in COS development involve creating measurement instruments and relevant endpoints for these outcomes.
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| 8. |
- Santamaria, Nick, et al.
(författare)
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Clinical performance characteristics for bordered foam dressings in the treatment of complex wounds : An international wound dressing technology expert panel review
- 2023
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 20:9, s. 3467-3473
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.
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| 9. |
- Strawbridge, Rona J., et al.
(författare)
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The overlap of genetic susceptibility to schizophrenia and cardiometabolic disease can be used to identify metabolically different groups of individuals
- 2021
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Understanding why individuals with severe mental illness (Schizophrenia, Bipolar Disorder and Major Depressive Disorder) have increased risk of cardiometabolic disease (including obesity, type 2 diabetes and cardiovascular disease), and identifying those at highest risk of cardiometabolic disease are important priority areas for researchers. For individuals with European ancestry we explored whether genetic variation could identify sub-groups with different metabolic profiles. Loci associated with schizophrenia, bipolar disorder and major depressive disorder from previous genome-wide association studies and loci that were also implicated in cardiometabolic processes and diseases were selected. In the IMPROVE study (a high cardiovascular risk sample) and UK Biobank (general population sample) multidimensional scaling was applied to genetic variants implicated in both psychiatric and cardiometabolic disorders. Visual inspection of the resulting plots used to identify distinct clusters. Differences between these clusters were assessed using chi-squared and Kruskall-Wallis tests. In IMPROVE, genetic loci associated with both schizophrenia and cardiometabolic disease (but not bipolar disorder or major depressive disorder) identified three groups of individuals with distinct metabolic profiles. This grouping was replicated within UK Biobank, with somewhat less distinction between metabolic profiles. This work focused on individuals of European ancestry and is unlikely
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