Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Clinical, Operational, and Economic Benefits of a Digitally Enabled Wound Care Program in Home Health: Quasi-Experimental, Pre-Post Comparative Study

BACKGROUND

The demand for home health care and nursing visits has steadily increased, requiring significant allocation of resources for wound care. Many home health agencies operate below capacity due to clinician shortages, meeting only 61% to 70% of demand and frequently declining wound care referrals. Implementing artificial intelligence-powered digital wound care solutions (DWCSs) offers an opportunity to enhance wound care programs by improving scalability and effectiveness through better monitoring and risk identification.

OBJECTIVE

This study assessed clinical and operational outcomes across 14 home health branches that adopted a DWCS, comparing pre- and postadoption data and outcomes with 27 control branches without the technology.

METHODS

This pre-post comparative study analyzed clinical outcomes, including average days to wound healing, and operational outcomes, such as skilled nursing (SN) visits per episode (VPE) and in-home visit durations, during two 7-month intervals (from November to May in 2020-2021 and 2021-2022). Data were extracted from 14,278 patients who received wound care across adoption and control branches. Projected cost savings were also calculated based on reductions in SN visits.

RESULTS

The adoption branches showed a 4.3% reduction in SN VPE and a 2.5% reduction in visit duration, saving approximately 309 staff days. In contrast, control branches experienced a 4.5% increase in SN VPE and a 2.2% rise in visit duration, adding 42 days. Healing times improved significantly in the adoption branches, with a reduction of 4.3 days on average per wound compared to 1.6 days in control branches (P<.001); pressure injuries, venous ulcers, and surgical wounds showed the most substantial improvements.

CONCLUSIONS

Integrating digital wound management technology enhances clinical outcomes, operational efficiencies, and cost savings in home health settings. A reduction of 0.3 SN VPE could generate annual savings of up to US $958,201 across the organization. The adoption branches avoided 1187 additional visits during the study period. If control branches had implemented the DWCS and achieved similar outcomes, they would have saved 18,546 healing days. These findings emphasize the importance of incorporating DWCSs into wound care programs to address increasing demands, clinician shortages, and rising health care costs while maintaining positive clinical outcomes.

45S5 Bioactive Glass-Ointment Positively Effects on Wound Healing in Rats by Regulating TNFα, Il-10, VEGF, and TGFβ

AIM

This study aimed to investigate the effects of 45S5 bioactive glass-ointment (BG) on cutaneous wound healing in rats at the molecular, biochemical, and histopathological levels.

MATERIALS AND METHODS

Thirty-two rats were divided into four groups (n = 8): Control, Sham, BG, and DEX (Dexpanthenol). While no wound treatment was applied to the CONTROL, a wound model was created in the Sham, and no treatment was applied. A wound model was created for other groups, and BG and DEX were applied locally for 21 days. During the 21-day experiment period, feed and water consumption and weight changes were observed. Wound areas were calculated on days 0, 3, 7, 4, and 21. Following treatment, the rats were euthanized and tissues from the wound area and blood samples were collected. While the expression levels of tumor necrosis factor-alpha (TNFα), Interleukin 6 (IL6), Interleukin 10 (IL10), transforming growth factor-beta (TGFβ), and vascular endothelial growth factor (VEGF) genes were determined by qPCR, the levels of TNFα, IL6, and IL10 proteins were measured by ELISA.

RESULTS

It was observed that the BG group showed anti-inflammatory activity by suppressing TNFα levels and stimulating IL-10. In addition, it was determined that BG increased fibroblast activity and vascularization.

CONCLUSION

Current findings showed that topical application of BG has anti-inflammatory effects, while also accelerating healing by increasing vascularity and making positive contributions to tissue healing.

Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria

BACKGROUND

Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses' perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people.

METHODS

We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings.

RESULTS

We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of 'acts of negotiations'.

CONCLUSION

Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the 'acts of negotiation' nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.

Outsourcing practice-based education: The role of industry representatives and implications for clinical expertise

In an era of significant human and fiscal constraints, hospitals increasingly rely on industry representatives to fill gaps related to practice-based education. Given their dual sales and support functions, the extent to which education and support functions are, or ought to be, fulfilled by industry representatives is unclear. We conducted an interpretive qualitative study at a large, academic medical centre in Ontario, Canada, during 2021-2022, interviewing 36 participants across the organization with direct and varied experiences with industry-delivered education. We found that ongoing fiscal and human resource challenges prompted hospital leaders to outsource practice-based education to industry representatives, which created an expanded role for industry beyond initial product rollouts. Outsourcing, however, generated downstream costs to the organization and undermined the goals of practice-based education. To attract and retain clinicians, participants advocated for re-investment in practice-based education in-house, with a limited and supervised role for industry representatives.

Frugal innovation in wound care: a critical discussion of what we can learn from low-resource settings

Frugal innovation is a common philosophy in low-income settings due to limited access to resources. However, with both the increasing prevalence and clinical acuity of patients with wounds in the UK, it is essential that alongside innovation such as harnessing cutting-edge new technologies, frugal innovation is also pursued. This may improve both economic efficiency and patient outcomes. Frugal innovations were adopted throughout the COVID-19 pandemic and included opportunistic solutions such as video-conferencing services to run clinics. However, there are many more opportunities for frugal innovation in wound care, including the use of smartphone technology, which is already accessible to 99.5% of UK clinicians caring for wounds, or the simplification of wound-assessment processes using pulse oximeters as an alternative to dopplers, as in the Lanarkshire Oximetry Index. This article explores what frugal innovation is and how it could improve UK wound services. The authors invite clinicians working in wound care to consider their access to existing resources that may not be considered useful for wound-care processes and explore how these could be used to improve clinical outcomes.

Promotion or education: a content analysis of industry-authored oral health educational materials targeted at acute care nurses

OBJECTIVES

To assess the nature, quality and independence of scientific evidence provided in support of claims in industry-authored educational materials in oral health.

DESIGN

A content analysis of educational materials authored by the four major multinational oral health product manufacturers.

SETTING

Acute care settings.

PARTICIPANTS

68 documents focused on oral health or oral care, targeted at acute care clinicians and identified as 'educational' on companies' international websites.

MAIN OUTCOME MEASURES

Data were extracted in duplicate for three areas of focus: (a) products referenced in the documents, (b) product-related claims and (c) citations substantiating claims. We assessed claim-citation pairs to determine if information in the citation supported the claim. We analysed the inter-relationships among cited authors and companies using social network analysis.

RESULTS

Documents ranged from training videos to posters to brochures to continuing education courses. The majority of educational materials explicitly mentioned a product (59/68, 87%), a branded product (35/68, 51%), and made a product-related claim (55/68, 81%). Among claims accompanied by a citation, citations did not support the majority (91/147, 62%) of claims, largely because citations were unrelated. References used to support claims most often represented lower levels of evidence: only 9% were systematic reviews (7/76) and 13% were randomised controlled trials (10/76). We found a network of 20 authors to account for 37% (n=77/206) of all references in claim-citation pairs; 60% (12/20) of the top 20 cited authors received financial support from one of the four sampled manufacturers.

CONCLUSIONS

Resources to support clinicians' ongoing education are scarce. However, caution should be exercised when relying on industry-authored materials to support continuing education for oral health. Evidence of sponsorship bias and reliance on key opinion leaders suggests that industry-authored educational materials have promotional intent and should be regulated as such.

Constructing a problem and marketing solutions: A critical content analysis of the nature and function of industry-authored oral health educational materials

AIMS AND OBJECTIVES

To document the nature of industry-authored educational materials focused on oral health; and analyse how they construct the relationships between nurses and industry.

BACKGROUND

Nurses frequently rely on pharmaceutical and medical device companies for continuing education. However, industry-sponsored education is a key aspect of multi-faceted promotional campaigns and may introduce bias into clinical decision-making.

DESIGN

Critical qualitative content analysis reported according to the COREQ checklist.

METHODS

We purposively sampled educational documents from the websites of 4 major manufacturers of oral health products for acute care. Two researchers analysed each document using an open-ended coding form. We conducted an interpretive analysis using inductive coding methods.

RESULTS

We included 63 documents that emphasised the importance of education in the form of training, expert guidance, evidence syntheses and protocols to support oral care practices. Industry promoted its relationship with nursing as an oral health authority through three dominant messages: (1) Pneumonia is a source of morbidity, mortality and treatment costs, which informed nurses about a critical problem; (2) Comprehensive oral care reduces pneumonia risk, which instructed nurses about product-oriented solutions; and (3) Frequent oral care is important, which emphasised compliance to standardised protocols. These messages formed an accountability logic that prompted clinicians to address a problem for which the company's products served as a solution. In doing so, industry validated dominant administrative concerns including compliance, while promoting product uptake.

CONCLUSIONS

Industry-authored educational materials may promote industry interests, rather than nursing or patient agendas. Dependence on industry's information and product solutions may have unintended, negative consequences for nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Though industry's educational materials present as convenient, helpful and evidence-based, they may serve to redirect care processes in ways that reinforce company goals rather than clinical priorities. Nurses should seek independent sources of continuing education where possible.