Click here for the Wounds UK Home Page December 2005

Tissue Viability Society reaches its 25th anniversary! What is tissue viability?	Best Wishes for the Holiday Season As we approach the end of another year it appears appropriate to review the highs - and the lows of pressure ulcers in 2005. Beginning on a positive note my outstanding highlight of the year was the partnership between the European Pressure Ulcer Advisory Panel (EPUAP) and the Tissue Viability Society (TVS) that delivered four days of strong conference presentations and debate in Aberdeen in early May. This event marked the first return of EPUAP to the UK since 1998 allowing UK delegates to share the latest pressure ulcer research, audit and clinical practice initiatives. Four moments stand out from the Aberdeen meeting - the launch of the Scottish Best Practice Statement on Pressure Ulcer treatment, the EPUAP statements on pressure ulcer monitoring and the identification of grade 2 pressure ulcers. The final highlight was the first presentation of an EPUAP project defining patients' experience of living with pressure ulcers. Each of these initiatives themselves made the meeting in Aberdeen worthwhile but together this marked a landmark conference in the growing history of the EPUAP. Of course memories of Aberdeen cannot be complete without fond thoughts of the conference dinner - good food, good company, drinks and dances and Dr George Cherry in a kilt! Other highlights of the year include the growing emphasis upon pressure ulcers in Parliament with several questions addressed to the Government this year. Perhaps next year these initiatives will produce answers beyond the bland response that pressure ulcers have been tackled by the issue of clinical practice guidelines and the Essence of Care process. While these are important steps it is surprising that politicians continue to accept a situation where high numbers of patients are affected with high costs incurred where there appears to be no interest in defining the scale of the problem and hence create the opportunity to identify improvements engendered by the NICE (and other) guidelines and Essence of Care. What of the lows of the year? Well apart from the continuing disinterest at a governmental level this year's lost opportunity was the recent NICE guideline on pressure ulcer treatment. Perhaps the guideline is not at fault but our weak evidence base certainly is! Selection of support surfaces is noted to be based on a clinical consensus view - with this view not supported (or refuted) by the weak evidence available to the guideline developers. Maybe the one present we need at this time of year is funding for high quality research to help answer the gaps and uncertainties in our understanding of pressure ulcers; their prevention and treatment. While we cannot blame the guideline for the evidence available the inclusion of grade 2 pressure ulcers as critical incidents seems likely to create unnecessary work while deflecting attention from severe pressure ulcers. The inclusion of Grade 2 pressure ulcers as critical incidents may not be helpful and it would be interesting to reflect upon how Trusts respond to this guidance in 2006. Michael Clark Editor	Keeping up to date with pressure area care Recent publications

Tissue Viability Society reaches its 25th anniversary! Next year, 2006, the Tissue Viability Society will have been in operation for 25 years. The longest established wound care/tissue viability membership organization world-wide the TVS has been sharing information through publications, conferences and courses from early times with no widespread interest in tissue viability, no specialist nurses, limited diffusion (and availability) of advanced wound dressings and sophisticated support surfaces through to today's busy wound environment with multiple societies, conferences and journals. To a large extent the TVS can rightly consider itself to be the foundation for much of today's wound care community. The 25th anniversary will be celebrated in style with a major conference in April (26th and 27th April 2006) in Birmingham focused upon pressure ulcers. Full details of the conference programme and booking information can be obtained at the TVS web-site www.tvs.org.uk. Other events will be held later in 2006 to mark the achievement of the TVS in supporting wound care over the past 25 years. Keep an eye out for the special editions of the Journal of Tissue Viability published in 2006 these will include a very special series of papers intended to celebrate 25 years of tissue viability. Keep reading for: What is tissue viability? Keeping up to date with pressure area care Download this newsletter in PDF format What is tissue viability? I was recently asked to succinctly define 'tissue viability'? Have you ever stopped to think what does this phrase mean and how you would explain it to others? Looking around a generally accepted definition does not seem to exist and here is your opportunity to fill this vacuum. Send me your definition of tissue viability (in under 100 words) with the best definition winning a copy of the forthcoming EPUAP book on pressure ulcers. Send entries to me at Wounds UK (enquiries@wounds-uk.com) with the the subject line "Pressure Care Newsletter Competition", to be received by the end of January 2006. The ten most interesting definitions will be reproduced in this newsletter so get thinking - how would you define 'tissue viability'? Keep reading for: Keeping up to date with pressure area care Download this newsletter in PDF format Pressure Ulcer References This month's pressure ulcer references have been taken from EMBASE, a bibliographic database that focuses upon primarily upon scientific, rather than clinical titles. Still there is lots of pressure ulcer references on this data-base with a selection of twenty-five 2005 references listed below. Adunsky A, Ohry A. Decubitus direct current treatment (DDCT) of pressure ulcers: Results of a randomized double-blinded placebo controlled study. Archives of Gerontology & Geriatrics. 2005; 41(3): 261-269. Albouy B, Treuillet S, Lucas Y, Barre H, Pichaud JC. Depth and colour analysis of wounds using digital camera. [French]. ITBM-RBM. 2005; 26(4): 240-242. Bansal C, Scott R, Stewart D, Cockerell CJ. Decubitus ulcers: A review of the literature. International Journal of Dermatology. 2005; 44(10): 805-810. Berthier F, Daideri G, Gendreike Y, Brocker P, Quaranta JF, Staccini P. Influence of the quality of CMA coding on the valorisation of a hospital's activity - An example about pressure ulcers. [French]. Journal D'Economie Medicale. 2005; 23(2): 73-81. Breuing KH, Bayer L, Neuwalder J, Orgill DP. Early experience using low-frequency ultrasound in chronic wounds. Annals of Plastic Surgery. 2005; 55(2): 183-187. Brienza DM, Geyer MJ, Jan YK. A comparison of changes in rhythms of sacral skin blood flow in response to heating and indentation. Archives of Physical Medicine & Rehabilitation. 2005; 86(6): 1245-1251. Castle NG. Nursing home closures and quality of care. Medical Care Research & Review. 2005; 62(1): 111-132. Castle NG, Degenholtz H, Engberg J. State variability in indicators of quality of care in nursing facilities. Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 2005; 60(9): 1173-1179. Cavalcanti Cordeiro MB, Antonelli EJ, Da Cunha DF, Jorda~o Jr AA, Rodrigues Jr V, Vannucchi H. Oxidative stress and acute-phase response in patients with pressure sores. Nutrition. 2005; 21(9): 901-907. Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: Age-period-duration effects. Archives of Physical Medicine & Rehabilitation. 2005; 86(6): 1208-1213. Cutajar R, Roberts A. The relationship between engagement in occupations and pressure sore development in Saudi men with paraplegia. British Journal of Occupational Therapy. 2005; 68(7): 307-314. Dimant J. Bariatric programs in nursing homes. Clinics in Geriatric Medicine. 2005; 21(4): 767-792. Dixon M, Ratliff C. Pediatric pressure ulcer prevalence--one hospital's experience. Ostomy Wound Management 2005;51(6):44-6. Donini LM, De Felice MR, Tagliaccica A, De Bernardini L, Cannella C. Comorbidity, frailty, and evolution of pressure ulcers in geriatrics. Medical Science Monitor. 2005; 11(7): CR326-CR336. Fleurence RL. Cost-effectiveness of pressure-relieving devices for the prevention and treatment of pressure ulcers. International Journal of Technology Assessment in Health Care. 2005; 21(3): 334-341. Gallagher S. Obesity and the aging adult: Ideas for promoting patient safety and preventing caregiver injury. Clinics in Geriatric Medicine. 2005; 21(4): 757-765. Gefen A, Gefen N, Linder-Ganz E, Margulies SS. In vivo muscle stiffening under bone compression promotes deep pressure sores. Journal of Biomechanical Engineering. 2005; 127(3): 512-524. Hierner R. Operative treatment of pressure sores: How and when? [German]. Zeitschrift fur Wundheilung. 2005; 10(3): 110-123. Kanoh M, Tadano T, Tanba T, Katayama H, Shimizu T, Sato Y, et al. Histopathologic changes in serum bile acid fractions in pressure ulcer patients. Hepato-Gastroenterology. 2005; 52(64): 1015-1018. Kuroda S, Akimoto M. Finite element analysis of undermining of pressure ulcer with a simple cylinder model. Journal of Nippon Medical School = Nihon Ika Daigahu Zasshi. 2005; 72(3): 174-178. Legaria MC, Lumelsky G, Rodriguez V, Rosetti S. Clindamycin-resistant Fusobacterium varium bacteremia and decubitus ulcer infection. Journal of Clinical Microbiology. 2005; 43(8): 4293-4295. Obara H, Kurihara Y, Doi M. Improvement effect of nutritional management on the long term hospitalized patients. [Japanese]. Iryo - Japanese Journal of National Medical Services. 2005; 59(6): 300-305. Raynaud-Simon A. Nutritional supplementation in elderly people. [French]. Nutrition Clinique et Metabolisme. 2005; 19(2): 90-94. Rithalia S. Assessment of patient support surfaces: Principle, practice and limitations. Journal of Medical Engineering & Technology. 2005; 29(4): 163-169. Turina M, Cheadle WG. Clinical challenges and unmet needs in the management of complicated skin and skin structure, and soft tissue infections. Surgical Infections. 2005; 6(SUPPL. 2): S-23-S-36.   Download this newsletter in PDF format