Standard Of Wound Care Research Articles

1448 Photo-Biomodulation(PBM) Therapy In Resistant Chronic Ulcers Caused By Kaposi's Sarcoma - An Effective Adjunct For Wound Healing

Abstract Introduction Photo-biomodulation (PBM), also known as low level Laser therapy (LLLT), is a novel non-pharmacological adjunct for enhancing the healing process of resistant wounds and ulcers. PBM promotes cellular proliferation and activates angiogenesis. We present a novel approach in the treatment of radiotherapy-related ulcer resistant to standard ulcer care. Case description A 60-year-old gentleman was referred with a complex left heel ulcer and pain following radiotherapy and chemotherapy post non-HIV related Kaposi's sarcoma resection. Conservative management failed and a below knee amputation was considered. The patient opted for an advanced therapy program. Repeated sessions of PBM were given (660 nm and 810 nm wavelength, 20Hz, 44.6 milliwatt/cm2, 26.76 Joules/cm2). The wound was covered with a novel fish skin xenograft Kerecis™ and supported with PICO™ dressing. A combination of further debridement, PBM, re-application of Kerecis™, PICO™ dressing and long-term antibiotics allowed a new vascularized layer with good pulsatile flow along wound edges to establish within 6 weeks at a rate of 4mm2/week. Achilles tendon was partially excised, and maggots were used. Full coverage of the ulcer bed with a new healthy granulation tissue was achieved in 12 weeks’ time. The pain improved dramatically, opioids were stopped, and the patient managed to mobilize independently again with occasional aids. The wound was allowed to heal with secondary intention. Conclusions PBM, Kerecis and best standards of wound care allowed avoiding a major amputation and healing of a malignancy-related and radiotherapy-related ulcer. PBM can be considered as an adjunct in slow / non-healing wounds for skin malignancies and radiotherapy patients.

Palliative Wound Care for PALTC

Palliative Wound Care for PALTC

Development of a National Wound Care Strategy: debating the issues.

Following on from the debate in the House of Lords (London, UK) 'Improving the standard of wound care in the NHS' in November 2017, Rt Hon. Lord Hunt of Kings Heath set up a meeting on 22 May to discuss the further action to be taken and work that has started to establish a National Wound Care Strategy.

Tissue viability in the hospice setting: joint working and blended learning to develop and demonstrate competent practice

Evidence suggests that 35% of people with life-limiting disease develop wounds towards the end of life and managing wounds in this population can be complex and challenging. The majority of...

Using ActivHeal®> dressings in a London teaching hospital: a cost analysis

Lower-cost 'generic' wound dressings are now available in the dressing categories of foams, films, alginates, gels and hydrocolloids. This offers the possibility of achieving significant financial savings while retaining good clinical standards of wound care. To test the potential for cost saving in a typical London teaching hospital, the ActivHeal range of dressings was substituted for normal 'branded' dressings over a 3-month period, during which dressing cost and clinical effectiveness were assessed. The result was an equivalent yearly cost saving of pound55 221 (54%), with retention of performance standards across the dressing range. Two years after the trial, wards in University College London Hospitals NHS Foundation Trust continue to benefit from significant annual cost savings on dressings by using the ActivHeal range of products, while maintaining a high standard of clinical care.

A point prevalence survey of wounds in north-east England

To review current wound-care practice and the standard of wound care in Hull and East Yorkshire; obtain information on prevalence, treatment and outcomes; provide a basis for estimating the extent of the problem, treatment modalities used, service provision and future needs; highlight areas of care in need of improvement; highlight areas with excellent wound practices and gain information for future research projects within the population of the region. Point prevalence interface audit of community and acute trusts. The cumulative wound prevalence for the region was 12%. Community nurses were involved in caring for 70.1% of patients with wounds, with 52.7% of wounds being treated in the patient's home. The largest proportion of wounds were surgical wounds (n=699, 41.5%), followed by leg and foot ulcers (n=629, 37.3%) and pressure ulcers (n=294, 17.4%). Diabetes and cancer were related to 15.1% and 9.7% of the wounds respectively. 41.9% of the wounds were on the lower leg. The primary and secondary dressings used the most were low/non-adherent dressings at 25.9% and 27.3% respectively.Almost half of the patients with a venous leg ulcer (46%) did not receive multilayer compression and 7% of patients with an arterial ulcer did; 23.6% of the leg and foot wounds were not assessed with a Doppler. Wounds represent a significant cause of morbidity in the general population.A systematic focus is necessary on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications.A number of initiatives have commenced in order to provide a effective and efficient wound care.

Treatment of Ischemic Wounds with Noncontact, Low-Frequency Ultrasound

To evaluate the clinical role of a novel, noncontact, low-intensity, low-frequency ultrasound therapy (MIST Therapy) in the treatment of nonhealing leg and foot ulcers associated with chronic critical limb ischemia. Prospective, parallel-group, randomized, controlled trial. A multidisciplinary, vascular wound-healing clinic. Thirty-five patients who received MIST Therapy plus the standard of wound care (treatment group) and 35 patients who received the standard of wound care alone (control group). Standard of wound care alone or standard of wound care plus MIST Therapy for 12 weeks or until fully healed. MIST Therapy was administered 3 times per week for 5 minutes per treatment. Percentage of patients with greater than 50% reduction in wound size from the index measurement after 12 weeks of treatment. The relationship of transcutaneous oximetry pressure in the supine and dependent position was evaluated as a factor in assessing the potential to heal ischemic ulcerations of the foot and leg. A significantly higher percentage of patients treated with the standard of care plus MIST Therapy achieved greater than 50% wound healing at 12 weeks than those treated with the standard of care alone (63% vs 29%; P < .001). Thus, failure to achieve the minimum wound healing requirement occurred in 37% of patients in the treatment group and 71% of patients in the control group. The predictive value of baseline transcutaneous oxygen pressure may benefit the clinician when assessing the potential to heal ischemic wounds. The rate of healing of cutaneous foot and leg ulcerations in patients with chronic critical limb ischemia improved significantly when MIST Therapy was combined with the standard of wound care.

Nurse Prescribing for Wounds

Summary To improve the standard of wound care in the Royal Bournemouth and Christchurch Hospitals NHS Trust a wound dressings formulary, wound assessment tool, wound prescription chart, selection of dressings poster and training were developed. A three month pilot of the wound assessment tool / prescription chart was conducted on six wards. Nurses completed a questionnaire (21 returns out of 30) 71% found the chart easy to use and 86% considered it an improvement on the previous system, particularly the integration of assessment and prescription. From a retrospective audit; 67% of the assessment forms were completed correctly, 93% of prescriptions were by an approved nurse and 64% of dressings were appropriate. Comparing with patients excluded from the pilot: wounds healed or healing; pilot 50%, non-pilot 35%, no progress; pilot 50%, non-pilot 62%, worse; non-pilot 3%. Implementation has occurred throughout the Trust. Further work is planned to continue training, to audit, to monitor expenditure and to investigate transfer of care to the community.