 |
Wounds UK November 2004 |
The Wounds UK conference in Harrogate Exhibition and Conference centre highlighted the growing number of disciplines involved in wound and leg ulcer management.
The stage was set for a very innovative programme and the key note speaker Courtney Lyder provided an eloquent and at times humourous look at issues of accountability in wound care practice in the United States. Extremely informative and entertaining, Courtney set the scene for a conference which has to be one of the best attended in the UK.
The theme of partnerships with commerce emerged in 'Question time', another session which proved interesting with many key issues discussed by the panel of experts and the audience.
Poster sessions ran throughout the event with an emphasis on showcasing some of the excellent work done by both new and more established wound care centres.
The afternoon plenary session was headlined by Keith Cutting and William Jeffcoate, both of whom examined wound infection from very different perspectives.
Day 2 began with free papers in the leg ulcer forum with some pioneering developments including pulse oximetry for arterial assessment and Digital Plethysmography to detect venous incompetence.
The afternoon on day 2 was dedicated to the issues surrounding pressure ulcer management, treatment and prevention with an excellent review of recent advances by Professor Dan Bader.
Overall the conference was huge success and Wounds UK hope to build on this success in the coming year by continuing to produce innovative and informative programmes to meet the needs of every level of wound care practitioner.
|
Honey: A Modern Wound Management Product |
Honey: A Modern Wound Management Product.
Eds: R J White, R A Cooper, P Molan.
Wounds-UK Publications Aberdeen
ISBN 0-9549193-0-0
This edited collection of chapters on modern honey useage in wound care includes reviews of the underlying science and clinical evidence to date. Also included are chapters on personal clinical experience from a number of well-known practitioners.
This book is aimed at all those involved in wound management on a regular basis: nurses, physicians and surgeons, podiatrists and so on.
The clinical evidence for the use of honey in wound management is steadily accumulating and, with the advent of various forms of manufactured honey dressings currently commercially available, or being developed, the flow of evidence will continue. Whilst the evidence pre-2000 was on generic honeys, more recent research has been focussed on the sterile Medical grade honey products intended specifically for wound management. These products have been designed to overcome many of the problems of messiness and difficulty of handling, making honey-based products as convenient to use as the more familiar modern wound dressings. Some involve the combination of honey with a modern dressing such as alginate or sheet hydrogel. Others present honey as a tubed formulation of amorphous gel or of ointment. This brings the most ancient form of wound dressing known into the realms of the most modern - an easy-to-use, bioactive dressing that provides a moist healing environment, with the advantage of having within a single product a range of actions (debriding, deodorising, antibacterial, growth-promoting, anti-inflammatory, and scar-minimising) usually available only
individually in a range of products. These attributes will, no doubt, be shown to be cost-effective in future clinical research.
In the meantime this book serves as the single, most comprehensive collection of data on honey extant.
|
The Election and the NHS |
Its election time again and unfortunately the NHS becomes the target for more promises by each of the parties vying for the support of the staff. It has become tradition that this is the time of the 'empty promise', during which much is said, about which nothing is done once the votes have been cast.
The growth of wound care, tissue viability and leg ulcer care and the associated costs of treatment has recently caught the eye of our politicians. This together with a growing number of lobyists seeking policy change to assist patients with chronic wound problems has pushed the speciality up the political agenda. It must be added here also that the recent scare stories surrounding MRSA have also placed wound care into the limelight, albeit for all the wrong reasons.
It has become apparent over the years that in order to achieve real change and real improvements in our service, the issue of wound care has to discussed at the highest level.
All of the main parties have published manifestos which outline their intentions should they be elected and their subsequent performance once in power will be carefully measured against these 'promises' by the opposition parties but most importantly the public.
It is important that as employees of the NHS, we must use the vote to ensure not only the survival of this institution but also to vote for the party which will nurture, assist and develop the service in a way which meets the needs of the patients and staff.
|
Dates for your diary |
16th May: Leg Ulcer Forum Conference at The Holiday Inn Taunton
The conference is titled 'Using Guidelines to Develop Skills and Services'
For Wounds UK Conferences follow this link
 |
|
What do we mean by 'The Ideal Wound Dressing' today? |
We recognise as health care professionals that the environment at the wound bed is not our only consideration today as our clinical decisions become as much driven by evidence based medicine as by health economic argument.
It is well established in the literature that the ideal dressing should create a moist wound environment at the wound interface, an ideal temperature in order to optimise cellular activity, be able to manage wound exudate, allow for gaseous exchange, and protect the wound from micro-organisms, contamination and traumatic injury (Morgan, 1997). With such a plethora of modern wound dressings available on the market today it is key for any clinician that the dressing selected meet as many of the needs of the wound as possible whilst still being cost effective.
One such debate at the moment relates to silver wound dressings. The issue for debate on many occasions returns to the level of silver within the dressing rather than considering what the clinician wants the silver in the dressing to do for the wound. Surely we must translate these factors into clinical effectiveness and clinical relevance within a health economic framework.
Therefore the argument needs to consider the following additional aspects of the dressing. Is their broad spectrum antimicrobial activity against wound pathogens including MRSA and VRE? Does the dressing provide immediate and sustained antimicrobial activity? Does the dressing manage large levels of exudate typically associated with infected wounds? Does the dressing create a moist wound healing environment? Is the dressing atraumatic for the patient at application and removal? If the dressing answers all of these questions favourably then the final question one must ask is, is the dressing cost effective?
In our clinical practice, we must consider all these factors when selecting the 'ideal' silver dressing and not look at any one aspect in isolation.
Product Focus: SurePress® Comfort™Pro
Indications
Under the supervision of a healthcare professional SurePress® Comfort™Pro may be used for in the following indications
Gross Varices
Post thrombotic venos insufficiency
Prevention and management of leg ulcers
Soft tissue support
Mode of Action
The two piece latex free stocking system combines to provide a nominal 35mm Hg compression at the ankle. This graduated compression, with the highest pressure around your ankles and the lowest beneath your knee, can help prevent the backflow of blood, a possible cause of leg ulcers.
Application
Put the silky white inner stocking on first. This stocking has a thin ribbed line as an ankle indicator. The indicator should be positioned around the smallest part of your ankle. The top of the stocking should lie just below your kneecap. Run your hands over the stocking to smooth out any wrinkles
Pull the overstocking on, ensuring that the toe and heel are aligned with the toe and heel area of the under stocking. The top of the two stockings must be aligned below the kneecap. Smooth out any wrinkles by running your hand over the stocking.
Please refer to the pack insert for full instructions prior to use
SurePress® Comfort™Pro
Features
A two piece graduated compression system
Provides 35mm Hg compression at the ankle (nominal)
Floating heel and ankle indicator design to facilitate correct alignment
Available in 5 sizes
Low friction surface
Maintains gradient of pressure for up to 60 washes at 40șC
Latex free
Benefits
May require less nurse training than multi layer bandage systems
May lead to improved patient compliance when compared with multi layer bandage systems
Less likely to disturb dressings
Easy for patient to apply and remove
Allows patients to wear their own shoes
|
Latest Journal References |
Abboud, C. (2004). "Wound management: who is responsible?" World Council of Enterostomal Therapists Journal 24(1): 28-30.
Andrews, J. (2004). "New wound care products focus on efficacy, flexibility, durability." Healthcare Purchasing News 28(1): 24.
A new generation of sophisticated products entering the 21st century market should finally put to rest the notion that purchasing wound care products is little more than ordering gauze by the truckload.
Anonymous (2004). "Chronic leg ulcers: surgery may prevent recurrence." Health News 10(8): 14.
Ashton, J. (2004). "Managing leg and foot ulcers: the role of Kerraboot." British Journal of Community Nursing 9(9): S26-30.
Foot and leg ulcers are chronic wounds characterized by slow or non-healing breakdown of epidermal and dermal tissue on the foot or below the knee. The prevalence is high and ulcers are a significant drain on the NHS in terms of nursing time and cost of dressings, and are incredibly burdensome to the individual patient. This article reviews the evidence for a new wound management system, Kerraboot, designed for the management of leg and foot ulcers. It is a boot-shaped dressing that completely surrounds the ulcer, creating an optimum healing environment. In clinical investigations, Keraboot offered patients relief from pain, was comfortable, easy to use and effectively controlled embarrassing odour, while also saving nursing time. Currently Kerraboot is recommended for the management of diabetic foot ulcers and venous ulcers where the patient is unable to tolerate compression therapy. [References: 16]
Banwell, P. E. (2004). "Topical negative pressure wound therapy: advances in burn wound management." Ostomy Wound Management 50(11A Suppl): 9S-14S.
Barringer, C. B., S. J. Gorse, et al. (2004). "The VAC dressing--a cautionary tale." British Journal of Plastic Surgery 57(5): 482.
Bauer, C. and J. Lindfors (2004). "Irrigation with saline. "A comparison of an antimicrobial wound cleanser to normal saline in reduction of bioburden and its effect on wound healing" (Ostomy/Wound Management. 2004;50[8]:28-41)." Ostomy/Wound Management 50(11): 13-4.
Bentley, J. (2004). "Preparing wounds for efficient tissue repair." Practice Nursing 15(11): 530-2.
Jenny Bentley looks at low to ensure efficient tissure repair through preparation of the wound, and highlights the variety of available wound management products.
Biala, K. Y., K. Cervantez, et al. (2004). "Building the foundations of wound care training: the need to fight the mantra "time is money"." Home Healthcare Nurse 22(5): 304-11.
The home care wound patient is continuing to grow and requires a significant organizational commitment to keep field staff current. One agency's successful effort to develop a wound management program is presented. [References: 8]
Bowler, P. G., S. A. Jones, et al. (2004). "Microbicidal properties of a silver-containing hydrofiber dressing against a variety of burn wound pathogens." Journal of Burn Care & Rehabilitation 25(2): 192-6.
Partial-thickness burns are often characterized by microbial contamination and copious exudate produced during the early postburn period. Consequently, topical wound management often relies on the use of antimicrobial agents and absorbent dressings, and an AQUACEL Hydrofiber Dressing containing ionic silver has been designed to meet such needs. To assess the antimicrobial properties of the AQUACEL Hydrofiber dressing, samples were challenged with a wide variety of recognized burn wound pathogens in a simulated wound fluid model. Dressing samples were inoculated with the challenge organisms at time zero and then reinoculated on days 4 and 9 to mimic the worst-case clinical scenario. The dressing was shown to be microbicidal against aerobic and anaerobic bacteria (including antibiotic-resistant strains), yeasts, and filamentous fungi during a 14-day test period. Based on our results, the silver-containing dressing is likely to provide a barrier to infection, in addition to providing proven fluid-handling benefits of the AQUACEL Hydrofiber dressing, in the management of partial-thickness burns.
Carville, K. and J. Smith (2004). "A report on the effectiveness of comprehensive wound assessment and documentation in the community." Primary Intention 12(1): 41-4.
This paper highlights the wisdom expressed here by Miss Nightingale in regard to the care of aged wounded war veterans in the domiciliary setting. Silver Chain Nursing Association is the largest provider of home care in Western Australia. In 2000 a wound survey was carried out on all Department of Veterans' Affairs (DVA) clients who were receiving wound management from Silver Chain. The aim of the survey was to review the prevalence, type and source of wounds on DVA clients referred, and to evaluate the nursing assessment and resources used to manage their wounds. A process was also established to review the times and costs involved in healing these wounds. In addition, when the findings of this study were compared with the findings of a wound prevalence survey that was conducted in 1996 amongst all Silver Chain clients who received nursing care, it was found that clients in the DVA study were 30% more likely to heal than those all-aged clients in the 1996 study. The significant reduction in healing rates and associated reduction in costs of wound healing were thought to be achieved when comprehensive nursing assessment and documentation were employed in the management of clients with wounds in the community.
Chaplin, J. (2004). "Wound management in palliative care." Nursing Standard 19(1): 39-42.
This article explores the challenges nurses face when caring for patients with wounds in a palliative care context. Combining the principles of effective wound management with the key elements of holistic, person-centred care will ensure that realistic and patient-focused aims of management are identified. Nurses with effective communication skills can play an important role in supporting patients and their families at a difficult time. [References: 38]
Clark, M. and P. E. Price (2004). "Is wound healing a true science or a clinical art?" Lancet 364(9443): 1388-9.
Cole, P. (2004). "Non-thermal infrared therapy for wound healing and pain." Acute Care Perspectives 13(2): 14-5.
Physical therapists have been using interventions such as electrical stimulation, infrared, ultrasound, and diathermy for decades to help patients with pain, musculoskeletal impairments, and for wound healing. Our profession has worked diligently to establish electrical stimulation as an accepted modality to improve wound healing outcomes. Recently, the use of electromagnetic therapy for wound healing (not to be confused with magnetic therapy) was approved. Currently, a multi-center trial is in progress for use of ultrasound delivered via a fine mist for wound management. Non-thermal infrared radiation is a newer adjunct therapy proposed to assist wound healing. Theories for mechanisms by which this modality may augment wound healing, indications, contraindications, and application of this modality are discussed.
Doult, B. (2004). "Leg Club could cut 1 billion pound annual wound care bill." Nursing Standard 19(5): 8.
Award-winning nurse urges leaders to consider roll-out of innovative care concept.
Dowsett, C. (2004). "The use of silver-based dressings in wound care." Nursing Standard 19(7): 56-60.
Chronic wounds such as leg ulcers and pressure ulcers are often slow to heal. One of the causes of delayed wound healing is the presence of micro-organisms in the wound. A strategy for the prevention and treatment of wound colonisation or infection, which is receiving renewed attention, is the use of silver-based dressings. Silver has been used as an antimicrobial agent for centuries. It is effective against a broad range of bacteria (including methicillin and vancomycin-resistant strains), yeast, fungi and viruses. A number of new silver-based dressings, some of which act by the sustained release of silver ions to the wound bed, have recently become available, but there are wide variations in the amount of data supporting the use of individual products. This article reviews the evidence base for silver-containing dressings to help practitioners select the most appropriate product for the type of wound being treated. [References: 30]
Franks, P. J. and N. Bosanquet (2004). "Cost-effectiveness: seeking value for money in lower extremity wound management." International Journal of Lower Extremity Wounds 3(2): 87-95.
This article discusses the different methods of evaluating cost in relation to the outcomes of treatment, and reviews the evidence of cost-effectiveness (CE) in the management of chronic leg ulceration. In essence, the CE argument revolves around the need to demonstrate outcomes of treatment in relation to particular levels of financial input by the health providers. High CE allows for either the same number of patients to be treated more efficiently (at a lower cost) or more patients to be treated for the same financial input. A review of medical and nursing databases (Medline, Embase, and Cinahl) identified studies of CE of dressing materials (n = 8), use of compression therapy (n = 4), and other treatments (n = 2). In addition, 5 research groups have undertaken studies to evaluate the relative CE of different systems of care. Overall conclusionsare that modern wound dressings provide a more cost-effective alternative to saline gauze, whereas the evidence relating to the use of tissue-engineered skin is less clear. The use of compression bandaging is substantially more cost-effective when compared with a system of care where compression is not systematically offered. The systems that offer compression are not only cost-effective but also lead to reductions in absolute cost. The evaluation of CE is likely to become an ever-increasing part of wound care evaluation as we strive to achieve greater efficiency in the use of scarce health resources.
Gomez, J. H., J. Schumacher, et al. (2004). "Effects of 3 biologic dressings on healing of cutaneous wounds on the limbs of horses." Canadian Journal of Veterinary Research 68(1): 49-55.
Three biologic dressings [split-thickness allogeneic skin (STS)], allogeneic peritoneum (P), and xenogenic porcine small intestinal submucosa (PSIS)] were studied to determine their effects on bacterial proliferation, inflammatory reaction, vascularization, and overall healing and to compare the effects of these dressings with the effects of a nonbiologic dressing, a nonadherent synthetic pad (NASP). A medial wound (3 cm in diameter) and 2 lateral wounds (2 cm in diameter) were created at the junction of the proximal and middle thirds of each metacarpus and metatarsus in 5 horses. Each medial wound and the proximolateral wound received an STS, P, PSIS, or NASP dressing on day 8 after wounding. The other lateral wound received an NASP dressing. Bacterial proliferation, inflammatory reaction (histologic changes), and drhessing vascularization were evaluated 6 d after application of the dressing. Percentages of contraction and epithelialization, as well as healing time, were determined when the wounds had completely epithelialized. The practical applicability of the different dressings to equine wound management was also assessed. No significant difference was detected in the parameters evaluated among the treated wounds or between the treated and control wounds. The biologic dressings had no effect on infection, inflammatory response, or healing time. Vascularization was not identified in any of the biologic dressings. The PSIS and P dressings required numerous applications over the study period. The STS dressings are more practical than PSIS and P dressings owing to ease of application and stability. Thus, these biologic dressings offer no apparent advantage over a nonbiologic dressing for treatment of small granulating wounds.
Graham, J. (2005). "Heel pressure ulcers and ankle brachial pressure index." Nursing Times 101(4): 47-8.
There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.
Gray, D., P. Cooper, et al. (2004). "Applied wound management: a clinical decision making framework." Irish Nurse 6(10): 35-7.
Recent developments in the field of wound management in particular the development of Wound Bed Preparation have led to an increased awareness of the need for a systematic approach to wound management. While the key principles of this approach, debridement, wound bio burden management and exudate management have been long established Wound Bed Preparation has sought to introduce a more systematic approach. Applied Wound Management seeks to develop this approach by utilising three continuums, Healing, Infection and Exudate to facilitate a systematic assessment of wounds healing by secondary intention. This approach not only supports clinical decision making but also facilitates clinical audit by allowing the majority of wound healing by secondary intention to be easily categorised. It should however be recognised that once an assessment has been completed consideration should be given to the underlying pathology of the wound and the treatment/management plan developed accordingly. Applied Wound Management and its associated software can not only support clinical decision making but provide a clinical audit tool which if utilised appropriately can provide valuable clinical outcome information.
Gray, D. and R. White (2004). "The wound exudate continuum: an aid to wound assessment." Scottish Nurse 9(4): 22.
Wound exudate is a key component of healing in the healthy wound. Traditionally, practitioners have considered exudate in terms of its volume alone. This approach fails to recognise the potential impact of wound exudate viscosity. Not only can the viscosity of wound exudate impact upon the absorptive performance of the wound dressing, but, can also provide a valuable insight into the underlying health of the wound., In this article, the authors present the Wound Exudate Continuum, an assessment tool intended for use as part of the Applied Wound Management framework. Through using-Wound Exudate Continuum, it becomes possible to assess both the viscosity and volume of the wound exudate in terms of the health of the wound, and, to rank the combination in terms of clinical significance. When utilised along side the Wound Healing and Wound Infection Continuums, a systematic approach to wound assessment can be achieved.
Gray, D., R. White, et al. (2004). "The wound healing continuum. an aid to clinical decision making and clinical audit." Scottish Nurse 9(1): 28-9.
This article is part of a series relating to Applied Wound Management, developed by Wounds-UK and supported by Johnson and Johnson Wound Management., Attempts have been made in the past to use colour as part of the wound assessment process. These methods have been useful but have failed to recognise the transient nature of the wound and where there maybe more than one colour present in the wound. The presence of unhealthy red tissue can also be ignored using traditional colour methods. The Wound Healing Continuum encourages users to think in terms of a progressions from the left of the continuum, black, rightwards to the end of the continuum, pink. It is recommended that users of this continuum recognise that the colour closest to the left of the continuum should be used to define the wound e.g. in a wound which contains black yellow and red tissue the wound could be categorised as a black wound or if there are approximately equal amounts of black and yellow tissue a black/yellow wound. The Wound Healing Continuum allows the categorisation of wound tissue based on clinical importance using colour as the clinical marker. This continuum is an effective audit tool and an aid to clinical decision making, it does not however replace sound clinical judgment.
Hess, C. T. and J. T. Trent (2004). "Incorporating laboratory values in chronic wound management." Advances in Skin & Wound Care 17(7): 378-86; quiz 387-8.
Hollinworth, H. (2004). "Sharing the burden: the complex practice of wound care in the community." British Journal of Community Nursing 9(1): 5-10.
Wound care in the community setting is often far from simple. Chronic wounds are the product of a complex interplay of processes that must all be addressed if healing, or an improvement in quality of life, is to be achieved. This case study highlights some of the complex issues faced in the community, and reinforces the need for all health professionals to continuously update their knowledge and skills.
Iglesias, C. P., E. A. Nelson, et al. (2004). "Economic analysis of VenUS I, a randomized trial of two bandages for treating venous leg ulcers." British Journal of Surgery 91(10): 1300-6.
BACKGROUND: The study investigated the cost-effectiveness of four-layer and short-stretch compression bandages for treating venous leg ulcers. METHODS: Cost-effectiveness and cost-utility analyses were performed using patient-level data collected alongside the VenUS I leg ulcer study. The perspective for the economic analysis was that of the UK National Health Service (NHS) and Personal Social Service. The time horizon for the analysis was 1 year after recruitment. Health benefit was measured as differences in ulcer-free days and quality-adjusted life years (QALYs).
RESULTS: The mean healing time for ulcers treated with four-layer bandages was 10.9 (95 per cent confidence interval (c.i.) -6.8 to 29.1) days less than that for ulcers treated with short-stretch bandages. Mean average difference in QALYs between compression systems was -0.02 (95 per cent c.i. -0.08 to 0.04). The four-layer bandage cost a mean of pound 227.32 (95 per cent c.i. pound 16.53 to pound 448.30) less per patient per year than the short-stretch bandage. CONCLUSION: On average, four-layer bandaging was associated with greater health benefits and lower costs than short-stretch bandaging. Copyright (c) 2004 British Journal of Surgery Society Ltd
Jeffcoate, W. J., P. Price, et al. (2004). "Wound healing and treatments for people with diabetic foot ulcers." Diabetes/Metabolism Research Reviews 20 Suppl 1: S78-89.
The factors that delay wound healing are multiple and relate both to diabetes and to the effect of its complications. Diabetic foot ulcers readily become chronic, and chronic ulcers have biological properties that differ substantially from acute ones. Much of the available information on the biology of wound healing relates to acute and experimental wounds and may not be directly relevant. It follows that there is limited evidence currently available to underpin protocols for the management of diabetic foot ulcers, or to guide choice of applications and dressings 1. Nevertheless, it is possible to define certain principles.GLYCAEMIC CONTROL: The first relates to glycaemic control. While chronic complications of diabetes such as peripheral vascular disease and neuropathy may be largely irreversible, aspects of structure and function of connective tissue and cells may be impaired by hyperglycaemia, and their function should be improved if normoglycaemia is achieved. PROMOTION OF HEALING: The second principle concerns attempts at active promotion of wound healing by (1) surgical revascularization, and (2) specific attempts to correct defined biological abnormalities thought to be hindering the healing process. These include the use of a variety of applications, dressings and technologies, which may stimulate healing by applying, or stimulating the release of, growth factors and cytokines. While this approach holds the greatest promise for the future, it will be dependent on defining defects which need correction in specific individuals, and having technologies available to address them. This field is in its infancy. WOUND CARE: The third broad principle concerns the management of the wound and its surrounding tissue in order to promote healing. This includes regular inspection, cleansing and removal of surface debris, elimination of pathogenic bacteria and creation of an appropriate environment to facilitate endogenous tissue regeneration. There are many applications and dressings that may be chosen to promote healing, but, whichever is selected, wound management has to be integrated into an effective programme of multidisciplinary care. Copyright 2004 John Wiley & Sons, Ltd. [References: 78]
Kane, F. M., E. E. Brodie, et al. (2004). "The analgesic effect of odour and music upon dressing change." British Journal of Nursing 13(19): S4-12.
Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain.
King, B. (2004). "Is this leg ulcer venous? Unusual aetiologies of lower leg ulcers." Journal of Wound Care 13(9): 394-6.
Lansdown, A. B. (2005). "A guide to the properties and uses of silver dressings in wound care." Professional Nurse 20(5): 41-3.
Silver-release dressings are extensively used for wound management, particularly in the treatment of burns, chronic leg ulcers and wounds requiring an antibacterial. A variety of products is now available. The properties and uses of these dressings are discussed, followed by a review of advances over recent years [References: 22]
Lindsay, E. (2004). "The Lindsay Leg Club Model: a model for evidence-based leg ulcer management." British Journal of Community Nursing Suppl: S15-20.
Leg Club is a unique model of community-based leg ulcer care. By providing nursing care in a non-medical, social environment, the model has several benefits: it removes the stigma associated with leg ulcers and helps isolated older people reintegrate into their communities, which in turn improves concordance and has a positive impact on healing and recurrence rates. In an atmosphere of de-stigmatisation, empathy and peer support, positive health beliefs are promoted and patients take ownership of their treatment. The Leg Club model creates a framework in which nurses, patients and local community can collaborate as partners in the provision of holistic care. The model also provides an environment for appropriate supportive education, advice and information. [References: 11]
Liu, J. Y., J. Hafner, et al. (2004). "Autologous cultured keratinocytes on porcine gelatin microbeads effectively heal chronic venous leg ulcers." Wound Repair & Regeneration 12(2): 148-56.
We have established a specific bioreactor microcarrier cell culture system using porcine gelatin microbeads as carriers to produce autologous keratinocytes on a large scale. Moreover, we have shown that autologous keratinocytes can be cultured on porcine collagen pads, thereby forming a single cell layer. The objective of this study was to compare efficacy and safety of autologous cultured keratinocytes on microbeads and collagen pads in the treatment of chronic wounds. Fifteen patients with recalcitrant venous leg ulcers were assigned to three groups in a single-center, prospective, uncontrolled study: five underwent a single treatment with keratinocyte monolayers on collagen pads (group 1); another five received a single grafting with keratinocyte-microbeads (group 2); and the last five received multiple, consecutive applications of keratinocyte-microbeads 3 days apart (group 3). All patients were followed for up to 12 weeks. By 12 weeks, there was a mean reduction in the initial wound area of 50, 83, and 97 percent in the three groups, respectively. The changes in wound size were statistically significant between the first and third groups (p= 0.0003). Keratinocyte-microbeads proved to be more effective than keratinocyte monolayers on collagen pads when the former were applied every 3 days. Rapid availability within 10-13 days after skin biopsy and easy handling represent particular advantages.
McErlean, B., S. Sandison, et al. (2004). "Skin tear prevalence and management at one hospital." Primary Intention 12(2): 83-6.
One organisation undertook a hospital-wide audit of skin tears to determine the type, location and current wound management practices in place. Prevalence varied greatly between wards, ranging from 0-3.8% in surgical wards to 27% in the palliative care ward. Using the Payne-Martin skin tear classification system, the majority of skin tears were categorised as 2A, partial thickness skin tears with less than 25% tissue loss. The audit discovered various management practices in places, some at variance with recommended wound care practices. To support consistency of practice, organisational practice guidelines were developed and are in the process of being disseminated to staff. Evaluation measures will consist of regular auditing practices, noting prevalence, location, causation factors and wound management practices, as well as staff knowledge.
Meaume, S., L. Teot, et al. (2004). "The importance of pain reduction through dressing selection in routine wound management: the MAPP study." Journal of Wound Care 13(10): 409-13.
OBJECTIVE: To discover the incidence of pain in patients with acute or chronic wounds of various causes during dressing removal, and the effect of switching to a non-adherent dressing. METHOD: A total of 656 primary care physicians reported the relevant details of all acute or chronic wounds observed during routine visits throughout the study period. The pain experienced during dressing changes was systematically evaluated. In patients with moderate to severe pain, a more extensive evaluation was performed and they were invited to complete a self-evaluation questionnaire. If the patients were seen at a subsequent visit, a new evaluation was performed. RESULTS: In total 5850 patients were seen: 2914 with acute wounds and 2936 with chronic wounds. During dressing changes, a similar number of patients with acute and chronic wounds reported 'moderate to severe' pain during the medical screening visit (79.9% and 79.7%) and 'very severe' pain in their self-evaluation questionnaire completed at home (47% and 59% respectively). Dressing removal was most painful when there was adherence to the wound bed. Switching to a new, non-adherent dressing reduced pain during dressing changes in 88% of patients with chronic wounds and 95% of patients with acute wounds. CONCLUSION: This study demonstrates that similar problems with patient acceptability arise irrespective of wound aetiology. Pain is a major problem and is most often related to dressing selection. Selecting a suitable, non-adherent dressing improves patient acceptability.
Mwipatayi, B. P., D. Angel, et al. (2004). "The use of honey in chronic leg ulcers: a literature review." Primary Intention 12(3): 107-8.
The purpose of this study was to investigate the clinical effects of topical honey on chronic leg ulcers, through a systematic review of published trials - randomised (RCTs) and non-RCTs - and to clarify its role in our daily practice. The Pubmed, MEDLINE, EMBASE, CINAHL database and the Cochrane Library were searched for relevant publications on the efficacy of honey as an antibacterial agent and in the promotion of wound healing in chronic leg ulcers 1980-2004. We found 13 publications concerning the use of honey in chronic leg ulcers, but only two were clinical trials of relevance to our study. The studies analysed were influenced by different sources of bias, especially lack of blinding, poor reporting quality and poor sample size. None of those studies was a RCT. In order to elucidate the evidence for the use of honey as a first line treatment in chronic leg ulcers, RCTs and laboratory studies on cellular effects are urgently needed.
Posthauer, M. E. (2004). "Diet, diabetes, and wound management: how important is glycemic control?" Holistic Nursing Practice 18(6): 318-20.
Raynor, P., J. Dumville, et al. (2004). "A new clinical trial of the effect of larval therapy." Journal of Tissue Viability 14(3): 104-5.
The VenUS II trial is the first large, prospective clinical study to investigate the effect of larval therapy and hydrogel on both the bacteriology and healing of leg ulcers. This trial will compare the clinical and cost effectiveness of two types of larval therapy (loose and bagged) with a standard debridement intervention (hydrogel) in terms of effects on time to complete healing, time to debridement, wound microbiology, cost of treatment and health-related quality of life. This paper describes the aims and design of the trial, outlines the eligibility criteria for patients and discusses the nurses' role in the study. This article has not been subject to peer review.
Schaum, K. D. (2004). "2004 Medicare legislation and regulations impact wound management." Advances in Skin & Wound Care 17(3): 113-4.
Shorney, R. H. (2004). "A model of compliance: understanding, satisfaction and recall in leg ulcer management." Nurse 2 Nurse 4(7): 51-3.
Tillman, D. (2004). "Uncommon causes of leg ulceration and lesions not to be missed." British Journal of Community Nursing Suppl: S23-8.
While the vast majority of cases of leg ulceration are the result of venous and/or arterial disease, and occur in older people, there are several other, less common conditions that can lead to leg ulceration, often in younger people. This article examines the diagnosis and management of some of these conditions, almost all of which will require referral for specialist assessment and treatment. [References: 11]
Verrillo, S. C. (2004). "Negative pressure therapy for infected sternal wounds: a literature review." Journal of Wound, Ostomy, & Continence Nursing 31(2): 72-4.
Sternal wound infections after cardiac surgery are infrequent yet serious complications for patients. Currently, there is no standardized approach to wound management once an infection occurs. Negative pressure therapy has shown some promising results in treating these wounds. The physiology of wound healing suggests that negative pressure therapy increases granulation and epithelialization in the patient's wound bed, which decreases the patient's healing time and pain, length of stay in the hospital, and cost of treating the infected sternal wound. Negative pressure therapy has been used in various wound types, but experimental research on sternal wound healing is limited. The purposes of this literature review are to summarize the significant findings of existing research on this issue and to suggest where further research is needed. To help ensure that care is based on the best evidence, future research should include the patient outcomes of healing time, length of stay, pain, and cost. [References: 12]
Vowden, K. (2004). "Wound management: the considerations involved in dressing selection." NursePrescribing 2(4): 152, 156 passim.
Dressing selection requires a careful assessment of the patient and wound, the development of an individualized clinical management plan and an evaluation of treatment effectiveness. Dressings have specific functions and appropriate product selection can aid healing and improve outcome and therefore the patient's quality of life by minimizing their symptoms. TELER (Treatment Evaluation by Le Roux's method) provides an effective way of monitoring care, both from the health professional's and the patient's perspective, and is a useful tool to assess progress.
Wilson, J. A. and J. J. Clark (2004). "Obesity: impediment to postsurgical wound healing." Advances in Skin & Wound Care 17(8): 426-35.
PURPOSE: To provide physicians and nurses with an overview of the impact of obesity on postoperative wound healing and how preplanning protocols can minimize skin and wound care problems in this patient population. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in reducing skin and wound care problems in their patients who are obese. OBJECTIVES: After reading the article and taking the test, the participant will be able to: 1. Identify obesity-related changes in body systems and how these impede wound healing. 2. Identify complications of postoperative wound healing in obese patients and the assessments and intervention strategies that can reduce these complications. 3. Identify skin and wound care considerations for obese patients and the role of preplanning protocols in avoiding problems. [References: 38]
.
|
Download this newsletter in PDF format