Click here for the Wounds UK Home Page April 2010

BMA News GUT Forthcoming Events

As the election approaches we are now exposed to much party rhetoric which will be tiresome to say the least. Not because of the promises the parties make, but rather that whatever happens, these promises do not make for positive change within the NHS once the parties get into power. I do not deny that there has been some progress made over the years, however, there is always the shadow of budget cuts in the public sector, which regardless of election outcome, appear inevitable. The speciality of tissue viability has become a key contributing factor in improving quality care across the NHS, yet the lack of representation in many PCT's may throw some doubt on this viewpoint. Recent government initiatives have all stressed the importance of quality, cost effective care for all and that the NHS should be striving to go from good to great (DoH 2009). Although anyone who has been in the NHS for the past 20 years will be aware that every 'new' initiative has more than a passing resemblance to those previously mooted. One of the key differences in the two main parties is where care will be delivered, one prefers centralisation of services and the other looks for a more fragmented localised approach, has anyone considered what patients and staff need and want?, I'm not so sure. I have also been watching the rise and rise of the health care assistant in healthcare, which in essence I have no problems with. Having well trained staff at all levels is important to ensure high quality care, however, I do take issue when HCA's are being used to do the job of a qualified nurse. In Glasgow there is a move to reduce the number of trained nurses by one third. If we are heading towards an all graduate profession, then why are we undermining much of the work which we do. Some argue that we do not need a trained nurse to carry out some of the more 'menial' tasks. I disagree, and in my experience I believe we all have to be able to deliver every level of care to patients from the most essential to the highly technical, in order to properly assess the patients' condition. One experience I had during an agency night shift in a dermatology ward gave me some insight. After an HCA had completed the observations, which was her normal role, I asked if there were any abnormalities among them and she could not say. This resulted in double work, as I had to check all the charts for myself. Is there any point in teaching someone to press the button on a Dinamap machine if they are not able to interpret the results. I must concede that this is not the fault of the HCA in question, rather the belief of the service that nurses roles can be diminished. I applaud the Salford Royal Foundation NHS trust who have recently removed much of the electronic equipment and replaced it with manual sphygmomanometers and stethoscopes, and found a 28% reduction in cardiac arrests since doing so. Why has this been successful, because a qualified nurse has monitored the pulse, assessed if the patient is clammy, distressed and made an holistic judgement on the patients' condition. I also spent the whole shift stopping staff from carrying bed pans through the clean preparation area. I was, I think, unpopular during that shift but many of the 'short cuts' happened to be core parts of my training which were passed on for a reason. In wound care, there is a risk of devaluing the work involved in tissue viability if we do not educate staff appropriately and assume that 'anyone can stick on a dressing'. While I believe that not all wounds need seen by a specialist, it is also true that some staff (trained and untrained) who view wounds are not able to pick up the subtle changes in the wound which could indicate infection or other complications. We should, as a group, create some guidance for the NHS which will safeguard patients with wounds and ensure treatment by the right person, in the right place at the right time. So regardless of who we decide to vote for in May, we have to read between the lines and look behind the spin. John Timmons Editor

Pisa International Diabetic Foot Courses Useful References      Latest references

BMA News Healthy living in middle age can help ward off dementia BMJ Clinical Evidence: Could early intervention be the key in preventing dementia? Having a healthy lifestyle in middle age is likely to help stave off dementia in later life, say two senior doctors in an editorial in BMJ Clinical Evidence. A recent report by the Alzheimer's Research Trust estimated that dementia currently costs the UK economy £23 billion per year, much more than previously thought, and this is set to increase. But evidence suggests that tackling risk factors such as obesity and high cholesterol in middle age could cut an individual's risk of developing dementia by about 20%, say Dr Tom Russ and Professor John Starr, experts in health and ageing at the University of Edinburgh. The most important areas to address are increasing levels of exercise across all age groups, and keeping obesity, blood pressure, and cholesterol levels under control in middle age. These measures will also have positive effects on heart disease, diabetes, and stroke. Modifying these risk factors early enough in life to have an effect is everybody's business, they write. Primary and secondary healthcare professionals, health promotion bodies, the voluntary sector and even employers will have to play a part for a national reduction in dementia incidence to occur. An alternative to rolling out these prevention initiatives population-wide is to specifically target people at high risk of dementia, they explain. However, they warn that there remains no preventative strategy proven to reduce the risk of developing dementia or to slow progression. Dementia will continue to be a condition that demands attention and resources in the coming years but, with adequate funding and urgent health promotion and preventative endeavours, it can be hoped that care-providers will not be taxed beyond their limits, they conclude. Contact: Dr Tom Russ, Alzheimer Scotland Clinical Research Fellow, Department of Geriatric Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland Tel (via Emma Dickinson, BMJ Press Office): +44 (0)20 7383 6529 Email: tom.russ@nhs.net Keep reading for: GUT Forthcoming Events Pisa International Diabetic Foot Courses Useful References Download this newsletter in PDF format GUT Indian spice may delay liver damage and cirrhosis [Curcumin improves sclerosing cholangitis in Mdr2 -/- mice by inhibition of cholangiocyte inflammatory response and portal myofibroblast proliferation Gut 2010; 59: 521-30] Curcumin, one of the principal components of the Indian spice turmeric, seems to delay the liver damage that eventually causes cirrhosis, suggests preliminary experimental research in the journal Gut. Curcumin, which gives turmeric its bright yellow pigment, has long been used in Indian Ayurvedic medicine to treat a wide range of gastrointestinal disorders. Previous research has indicated that it has anti-inflammatory and antioxidant properties which may be helpful in combating disease. The research team wanted to find out if curcumin could delay the damage caused by progressive inflammatory conditions of the liver, including primary sclerosing cholangitis and primary biliary cirrhosis. Both of these conditions, which can be sparked by genetic faults or autoimmune disease, cause the liver's plumbing system of bile ducts to become inflamed, scarred, and blocked. This leads to extensive tissue damage and irreversible and ultimately fatal liver cirrhosis. The research team analysed tissue and blood samples from mice with chronic liver inflammation before and after adding curcumin to their diet for a period of four and a period of eight weeks. The results were compared with the equivalent samples from mice with the same condition, but not fed curcumin. The findings showed that the curcumin diet significantly reduced bile duct blockage and curbed liver cell (hepatocyte) damage and scarring (fibrosis) by interfering with several chemical signalling pathways involved in the inflammatory process. These effects were clear at both four and eight weeks. No such effects were seen in mice fed a normal diet. The authors point out that current treatment for inflammatory liver disease involves ursodeoxycholic acid, the long term effects of which remain unclear. The other alternative is a liver transplant. Curcumin is a natural product, they say, which seems to target several different parts of the inflammatory process, and as such, may therefore offer a very promising treatment in the future. Contact: Professor Michael Trauner, Laboratory of Experimental and Molecular Hepatology, Department of Internal Medicine, Medical University, Graz, Austria. Tel (mobile): +43 664 421 594 Email: Michael.trauner@meduni-graz.at Keep reading for: Forthcoming Events Pisa International Diabetic Foot Courses Useful References Download this newsletter in PDF format Forthcoming Events Lymphoedema Conference and Skin Changes in the Lower Limb Conference ROYAL ASCOT - 20 - 22 April 2010 Click here to download the programme Nursing in practice awards 2010 Click here to download an information pack The British Association of Skin Camouflage - Celebrates it's 25th anniversary Click here to download a recent press release Multi-Professional Week Click here to download more information Keep reading for: Pisa International Diabetic Foot Courses Useful References Download this newsletter in PDF format Pisa International Diabetic Foot Courses 4 day theoretical course and practical training 4-7 October 2010 Registration open CLICK HERE FOR INFORMATION ON FEES AND ONLINE REGISTRATION Low registration fee - deadline 30 June 2010 The course offers: A thorough introduction to all aspects of the diagnosis, management and treatment of the diabetic foot, based on international consensus Practical training sessions in the diabetic foot clinic Access to follow up support for diabetic foot clinic establishment The course programme, faculty list and general information is available at www.diabeticfootcourses.org If you have any further questions about the courses you are very welcome to contact the course secretariat. Kind regards, Prof. Alberto Piaggesi Director of the Diabetic Foot Section of the Pisa University Hospital, University of Pisa Course secretariat: Pisa International Diabetic Foot Courses C/o Congress Consultants Martensens Allé 8 DK-1828 Frederiksberg C Denmark Tel: +45 70 20 03 05 Fax: +45 70 20 03 15 Mail: info@diabeticfootcourses.org Web: www.diabeticfootcourses.org Keep reading for: Useful References Download this newsletter in PDF format References Boone, D.; Braitman, E.; Gentics, C.; Afthinos, J.; Latif, J.; Sordillo, E.; Todd, G.; Lantis, J.C.(2010) Bacterial Burden and Wound Outcomes as Influenced by Negative Pressure Wound Therapy. WOUNDS VOL 22; NUMB 2; pp. 32-37 Kamer, E.; Unalp, H.R.; Gundogan, O.; Diniz, G.; Ortac, R.; Olukman, M.; Derici, H.; Onal, M.A. (2010) Effect of Ascorbic Acid on Incisional Wound Healing in Streptozotocin-Induced Diabetic Rats. WOUNDS VOL 22; NUMB 2; pp. 27-31 van Ramshorst, G.H.; Vrijland, W.; van der Harst, E.; Hop, W.C.J.; Hartog, D.d.; Lange, J.F. (2010) Validity of Diagnosis of Superficial Infection of Laparotomy Wounds Using Digital Photography: Inter- and Intra-observer Agreement Among Surgeons. WOUNDS VOL 22; NUMB 2; pp. 38-43   Download this newsletter in PDF format