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Queen D, Botros M, Harding K. International opinion-The true cost of wounds for Canadians. Int Wound J 2024; 21:e14522. [PMID: 38084491 PMCID: PMC10777746 DOI: 10.1111/iwj.14522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024] Open
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Queen D, Harding K. What's the true costs of wounds faced by different healthcare systems around the world? Int Wound J 2023; 20:3935-3938. [PMID: 37963846 PMCID: PMC10681396 DOI: 10.1111/iwj.14491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 11/16/2023] Open
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Sezgin D, Geraghty J, Graham T, Blomberg K, Charnley K, Dobbs S, McElvaney A, Probst S, Beeckman D, Grocott P, Gethin G. Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce. J Tissue Viability 2023; 32:627-634. [PMID: 37482507 DOI: 10.1016/j.jtv.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION A review protocol was developed but not registered.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - Jemell Geraghty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Tanya Graham
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care (AIIHPC), Dublin, Ireland
| | - Sharon Dobbs
- Wellington Hospital HCA Healthcare, London, United Kingdom
| | - Aideen McElvaney
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Sebastian Probst
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Geneva, Switzerland; University Hospital Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Sweden
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
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Somani AK, Atkin L, Bechara FG, Davidson JM, Jeffery S, Mostow E, Simman R, Armstrong DG, Karatzias A, Martínez JLL, Milne J, de Ceniga MV. Practical applications of small intestine submucosa extracellular matrix (SIS-ECM) an expert panel consensus. J Wound Care 2023; 32:S1-S16. [PMID: 37703212 DOI: 10.12968/jowc.2023.32.sup9b.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Ally-Khan Somani
- Director of Dermatologic Surgery and Cutaneous Oncology Division; Assistant Professor, Department of Dermatology; and Adjunct Assistant Professor of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, US
| | - Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Falk G Bechara
- Head of the Department of Dermatologic Surgery, Ruhr-University, Bochum, Germany
| | - Jeffrey M Davidson
- Emeritus Professor of Pathology, Microbiology and Immunology, Vanderbilt University, School of Medicine, Nashville, Tennessee, US
| | - Steve Jeffery
- Professor of Wound Study, Birmingham, City University; Medical Director, Pioneer Wound, Telehealth, Birmingham, UK
| | - Eliot Mostow
- Head of the Dermatology Section, Northeast Ohio Medical University; Clinical Faculty, Case Western University, Ohio, US
| | - Richard Simman
- Professor of Plastic Surgery, University of Toledo College of Medicine and Life, Sciences; Jobst Vascular Institute, ProMedica Health, System, Toledo, Ohio, US
| | - David G Armstrong
- Professor of Surgery and Director of the Limb Preservation Program, University of Southern California, US
| | | | - José Luis Lázaro Martínez
- Tenured Professor and Clinical Director of the Diabetic Foot Unit, Complutense University of Madrid, Spain
| | - Jeanette Milne
- Clinical Lead for Tissue Viability, Northumbria Healthcare NHS Foundation Trust, UK
| | - Melina Vega de Ceniga
- Consultant Angiologist and Vascular and Endovascular Surgeon, Galdakao‑Usansolo Hospital, Bizkaia, Spain
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Romary DJ, Landsberger SA, Bradner KN, Ramirez M, Leon BR. Liquid ozone therapies for the treatment of epithelial wounds: A systematic review and meta-analysis. Int Wound J 2023; 20:1235-1252. [PMID: 36056800 PMCID: PMC10031250 DOI: 10.1111/iwj.13941] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Ozonated water and ozonated oils are emerging as potential therapies for wound care, but their efficacy has not been appropriately evaluated. The aim of this systematic review and meta-analysis was to evaluate the therapeutic potential of topical ozone in the treatment of mammalian wounds. A structured search of five scientific databases returned a total of 390 unique studies. Of these, 22 studies were included in this review. Four studies provided enough data to be included in a meta-analysis evaluating the time to complete wound healing. All studies were randomised controlled trials of humans or other mammalian animals that reported clinical signs of wound healing. Each study was critically analysed by a six-point assessment of the risk of bias. Wounds treated with topical ozone had a greater reduction in wound size than similar wounds treated with controls or standard of care in all studies. Those treated with ozonated liquids also had a shorter time to wound healing by approximately one week. In conclusion, topical ozone contributed to enhanced wound healing in all studies. While additional human experiments would be helpful to quantify ozone's specific effects on wound healing compared to standard treatment, topical ozone should be considered as part of an overall wound management strategy.
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Affiliation(s)
| | | | - K. Nicole Bradner
- Academic Health Center PharmacyIndiana University HealthIndianapolisIndianaUSA
| | - Mirian Ramirez
- School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Brian R. Leon
- School of MedicineIndiana UniversityIndianapolisIndianaUSA
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May P, Moriarty F, Hurley E, Matthews S, Nolan A, Ward M, Johnston B, Roe L, Normand C, Kenny RA, Smith S. Formal health care costs among older people in Ireland: methods and estimates using The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2023; 6:16. [PMID: 37829548 PMCID: PMC10565419 DOI: 10.12688/hrbopenres.13692.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 10/14/2023] Open
Abstract
Background: Reliable data on health care costs in Ireland are essential to support planning and evaluation of services. New unit costs and high-quality utilisation data offer the opportunity to estimate individual-level costs for research and policy. Methods: Our main dataset was The Irish Longitudinal Study on Ageing (TILDA). We used participant interviews with those aged 55+ years in Wave 5 (2018) and all end-of-life interviews (EOLI) to February 2020. We weighted observations by age, sex and last year of life at the population level. We estimated total formal health care costs by combining reported usage in TILDA with unit costs (non-acute care) and public payer reimbursement data (acute hospital admissions, medications). All costs were adjusted for inflation to 2022, the year of analysis. We examined distribution of estimates across the population, and the composition of costs across categories of care, using descriptive statistics. We identified factors associated with total costs using generalised linear models. Results: There were 5,105 Wave 5 observations, equivalent at the population level to 1,207,660 people aged 55+ years and not in the last year of life, and 763 EOLI observations, equivalent to 28,466 people aged 55+ years in the last year of life. Mean formal health care costs in the weighted sample were EUR 8,053; EUR 6,624 not in the last year of life and EUR 68,654 in the last year of life. Overall, 90% of health care costs were accounted for by 20% of users. Multiple functional limitations and proximity to death were the largest predictors of costs. Other factors that were associated with outcome included educational attainment, entitlements to subsidised care and serious chronic diseases. Conclusions: Understanding the patterns of costs, and the factors associated with very high costs for some individuals, can inform efforts to improve patient experiences and optimise resource allocation.
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Affiliation(s)
- Peter May
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Frank Moriarty
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eimir Hurley
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Soraya Matthews
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anne Nolan
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Economic and Social Research Institute, Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Bridget Johnston
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lorna Roe
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Charles Normand
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Samantha Smith
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Cuddigan J, Haesler E, Moore Z, Carville K, Kottner J. Development, dissemination and evaluation of a smartphone-based app for pressure ulcer/injury prevention and treatment for use at the bedside. J Wound Care 2022; 31:S29-S39. [PMID: 36475841 DOI: 10.12968/jowc.2022.31.sup12.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE After launching the 2019 International Pressure Ulcer/Injury Guideline, the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) collaborated with Sensorydata Corp., US, to develop a guideline app (InterPIP App). The app was designed to: present evidence-based guideline recommendations; incorporate search capacities and functionality to facilitate easy access to clinical guidance; provide accessibility in multiple languages; and to be available worldwide at a reasonable price, including opportunities for free access in low-resource countries. This paper describes the development, dissemination and formative evaluation of a mobile app providing evidence-based recommendations for pressure injury prevention, assessment/classification, and treatment at the point of care. METHOD An evaluation tool was designed based on a framework developed by Nouri et al. and made available to all app subscribers. RESULTS The InterPIP App is currently available in 11 languages and had been downloaded 3616 times by February 2022 in 78 countries. A total of 62 individuals responded to the survey of end-users. In this formal evaluation of user experiences, the app was rated positively on criteria of: information/content; usability; design; functionality; ethics; and security/privacy (median=4 on a 1-5 Likert scale). Overall perceived value was ranked lower with a median of three. Users provided suggestions for ongoing app enhancement. CONCLUSION The InterPIP App offers a unique opportunity to bring evidence-based guidance to the point of care. Formal evaluation of end-user experiences identified opportunities for quality improvement, and informed plans for future development and evaluation.
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Affiliation(s)
- Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, US
| | - Emily Haesler
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Australian Centre for Evidence Based Aged Care, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Canberra, Australian Capital Territory, Australia
| | - Zena Moore
- Royal College of Surgeon in Ireland University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland.,Cardiff University, Cardiff, Wales.,Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Department of Public Health; Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai, China
| | - Keryln Carville
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Australia
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
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Moore ZEH, Aynge GE, Carr CG, Horton AJ, Jones HA, Murphy NS, Payne MR, McCarthy CH, Murdoch JM. A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance. Int Wound J 2022; 19:1263-1275. [PMID: 35793908 PMCID: PMC9284651 DOI: 10.1111/iwj.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022] Open
Abstract
Wounds continue to be of a global concern. Therefore, a more focussed, evidence-based approach to wound assessment and management is required. The WOUND COMPASS™ Clinical Support App (CSA) is designed to support the health care professional with wound assessment and management at the point of care. This real-world pilot study aimed to determine the utility of the CSA during routine wound management, in multiple care settings. A non-interventional, real-world pilot programme of the CSA was conducted at four sites. Patients received routine wound management. The CSA was programmed to replicate the site's formulary for evidence-based wound management. Anonymised pre- and post-pilot clinician opinion surveys on useability and impact of the CSA were collected and reported. Wound Specialists (n = 7 [100%]) and Non-Wound Specialists (NWS) (n = 58 [82%]) indicated that competence and confidence in wound assessment were enhanced with use of the CSA (100%; 82%). Furthermore, practice variation was reduced because of a greater compliance to their local formulary (n = 7 [100%]; 79% [54%]). This real-world pilot shows the positive impact of the CSA, and the improvements that can be potentially realised via reduction in practice variation, improvement in NWSs confidence when managing wounds and increased formulary compliance.
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Affiliation(s)
- Zena E H Moore
- Skin Wounds and Trauma (SWaT) Research Centre, School of Nursing and Midwifery, RCSI University of Medicine and Health Services, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Ulster, UK.,School of Medicine, Cardiff University, Cardiff, UK.,Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,School of Nursing and Health, Lida Institute, Shanghai, China
| | - Georgina E Aynge
- Tissue Viability, Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
| | - Caryn G Carr
- Tissue Viability, Southern Health NHS Foundation Trust, Long Term Conditions Centre, Lyndhurst, UK
| | - Aundrea J Horton
- Education, Home Health and Hospice HCA, Nashville, Tennessee, USA
| | - Hayley A Jones
- Tissue Viability, Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
| | - Nina S Murphy
- Interim Operational Lead for Long Term Condition, Northeast London Foundation Trust, Mayflower Community Hospital, Blunts, UK
| | - Matthew R Payne
- Tissue Viability, Southern Health NHS Foundation Trust, Long Term Conditions Centre, Lyndhurst, UK
| | - Catherine H McCarthy
- Global Clinical Strategy - Advanced Wound Management, Smith and Nephew, Watford, UK
| | - Julie M Murdoch
- Global Clinical Strategy - Advanced Wound Management, Smith and Nephew, Watford, UK
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Ruíz-Antúnez E, Nieto-García A, Alonso-Sardón M. Clinical Burden of Inpatient Wound Care in Internal Medicine Units During the First Wave of COVID-19 Outbreak. Adv Skin Wound Care 2022; 35:1-7. [PMID: 35426846 DOI: 10.1097/01.asw.0000824564.25976.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore the clinical burden and epidemiologic profile of hospitalized patients with wounds during the first wave of COVID-19. METHODS A retrospective and observational study was conducted to analyze the inpatient episodes of wound care in the University Hospital of Salamanca (Spain) during the initial COVID-19 crisis from March 1, 2020, to June 1, 2020. Data were collected from nursing care reports and clinical discharge reports. Included patients were 18 years or older, had a hospital length of stay of 1 day or longer, and were hospitalized in an internal medicine unit. Surgical and traumatic wounds and pediatric patients were excluded. RESULTS A total of 116 patients and 216 wounds were included. The overall wound prevalence was 7.6%, and incidence was 3.5% in the internal medicine units. Pressure injuries (PIs) were the most common wound type, and patients with COVID-19 had significantly higher PI risk (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-4.0; P = .042). Significant differences in PI staging were noted: 83.2% of wounds in patients with COVID-19 were stages I-II versus 67.8% in patients without COVID-19; the probability of stage III-IV PIs among patients without COVID-19 was doubled (OR, 2.3; 95% CI, 1.2-4.5; P = .009). The probability of acute wounds tripled in patients with COVID-19 (OR, 3.7; 95% CI, 2.1-6.6; P < .001). Patients with COVID-19 also had longer mean hospital stays and higher ICU admission rates. No case fatality rate differences were observed. CONCLUSIONS In this context of clinical practice, protocolized assessment and implementation of preventive measures must be ensured among older adult populations, patients with associated comorbidities, and ICU patients.
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Affiliation(s)
- Leticia Nieto-García
- Leticia Nieto-García, RN, PT, is PhD Student and Research Nurse, Institute for Biomedical Research of Salamanca, Spain. At the University Hospital of Salamanca, Adela Carpio-Perez, MD, PhD, is Internal Medicine Physician; Maria Teresa Moreiro-Barroso, MD, is Internal Medicine Physician; Emilia Ruíz-Antúnez, RN, is Nurse, Department of Training, Development and Innovation; and Ainhoa Nieto-García, is Social Worker and Nursing Student. Montserrat Alonso-Sardón, MD, PhD, MPH, is Full Professor of Preventive Medicine, Epidemiology and Public Health, University of Salamanca. The authors have disclosed no financial relationships related to this article. Submitted June 24, 2021; accepted in revised form November 2, 2021; published online ahead of print April 15, 2022
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10
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Moloney S, McGrath BM, Roshan D, Gethin G. The Personal Impact of Daily Wound Care for Hidradenitis Suppurativa. Dermatology 2021; 238:762-771. [PMID: 34929704 DOI: 10.1159/000520262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recurring nodules, abscesses, and lesions characterise hidradenitis suppurativa (HS): a chronic, inflammatory skin disorder. Globally the prevalence of HS is estimated to be around 1% of the population. Leakage, pain, and odour from HS wounds require substantial management. Little is known of the personal burdens that routine wound management imposes on the patient. OBJECTIVES To evaluate how routine HS wound management impacts patients in terms of the time spent changing dressings, the number of dressings required per day, pain experienced during dressing changes, and negative impact on various domains of their personal lives. METHODS An anonymous online questionnaire was posted on closed social media patient support groups between April and May 2019. Pearson χ2 test was used to evaluate if Hurley stages influenced the personal impact of wound care routines on patients. Statistical significance was determined as p value <0.05. RESULTS In total, 908 people from 28 countries responded. Of these, 81% (n = 734) reported that regular dressing changes negatively impacted on their quality of life. Most patients, 82% (n = 744), experience pain during dressing changes. 16% (n = 142) of patients required five or more dressings daily, and 12% (n = 108) spend over 30 min daily tending to wounds. Patients indicated high levels of dissatisfaction with currently available wound dressings. CONCLUSION HS wound management imposes a substantial personal burden on patients. There is a clear unmet need for HS-specific wound dressings and wound care provisions, and a greater awareness of the condition and its impact is needed among clinicians.
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Affiliation(s)
- Suzanne Moloney
- HidraMed Solutions, Business and Innovation Centre, National University of Ireland, Galway, Ireland
| | - Barry M McGrath
- HidraMed Solutions, Business and Innovation Centre, National University of Ireland, Galway, Ireland
| | - Davood Roshan
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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11
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Gethin G, Probst S, Stryja J, Christiansen N, Price P. Evidence for person-centred care in chronic wound care: A systematic review and recommendations for practice. J Wound Care 2021; 29:S1-S22. [PMID: 32935648 DOI: 10.12968/jowc.2020.29.sup9b.s1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic wounds affect an estimated 2.21 per 1000 population. They are a significant source of morbidity and affect individuals physically, psychologically, socially and financially. Person-centered care is one approach to improve patient outcomes in wound care as it values patients' perspectives, beliefs and autonomy and considers the person as a whole within the cultural context in which care is provided. AIM We aimed to review the evidence on the use of person-centered care (PCC) in chronic wound care management and provide recommendations for practice and future research. METHOD Using a systematic review methodology, we searched six databases for full-text papers from 2009-2019 published in peer-reviewed journals with no limits on language. RESULTS Eighteen articles on studies involving 3149 patients from nine countries were identified. Studies were conducted under three broad intervention categories: healthcare professional education (n=1); patient education (n=14) and telemedicine (n=3). Studies were equally focused on prevention and treatment of chronic wounds. Significant improvements were reported in patient knowledge, pain and self-care behaviours. Only two studies evaluated the impact on wound healing and one study estimated the cost of implementing person-centered care. CONCLUSIONS The evidence base to support PCC in wound management is developing and based on our review has shown improved outcomes in areas of pressure ulcer prevention, patient satisfaction, patient knowledge and quality of life, but clinical outcomes such as wound healing were less well explored. Further research with more objective outcome measures are required.
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Affiliation(s)
- Georgina Gethin
- (Editor), Head of School. School of Nursing and Midwifery, NUI Galway, Galway, Ireland, Alliance for Research and Innovation in Wounds, NUI Galway, Galway, Ireland, Monash University, Melbourne, Australia
| | - Sebastian Probst
- Professor of Tissue Viability and Wound Care, HES-SO University of Applied Science and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | - Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, the Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients' department, Trinec, The Czech Republic
| | | | - Patricia Price
- Professor of Burn Injury Research, Centre for Global Burn Injury Policy and Research, Swansea University and Emeritus Professor, Cardiff University
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12
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Smith S, Jiang J, Normand C, O’Neill C. Unit costs for non-acute care in Ireland 2016—2019. HRB Open Res 2021; 4:39. [PMID: 35317302 PMCID: PMC8917322 DOI: 10.12688/hrbopenres.13256.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background: This paper presents detailed unit costs for 16 healthcare professionals in community-based non-acute services in Ireland for the years 2016—2019. Unit costs are important data inputs for assessments of health service performance and value for money. Internationally, while some countries have an established database of unit costs for healthcare, there is need for a more coordinated approach to calculating healthcare unit costs. In Ireland, detailed cost analysis of acute care is undertaken by the Healthcare Pricing Office but to date there has been no central database of unit costs for community-based non-acute healthcare services. Methods: Unit costs for publicly employed allied healthcare professionals, Public Health Nurses and Health Care Assistant staff are calculated using a bottom-up micro-costing approach, drawing on methods outlined by the Personal Social Services Research Unit in the UK, and on available Irish and international costing guidelines. Data on salaries, working hours and other parameters are drawn from secondary datasets available from Department of Health, Health Service Executive and other public sources. Unit costs for public and private General Practitioner, dental, and long-term residential care (LTRC) are estimated drawing on available administrative and survey data. Results: The unit costs for the publicly employed non-acute healthcare professionals have changed by 2–6% over the timeframe 2016–2019 while larger percentage changes are observed in the unit costs for public GP visits and public LTRC (14-15%). Conclusions: The costs presented here are a first step towards establishing a central database of unit costs for non-acute healthcare services in Ireland. The database will help ensure consistency across Irish health costing studies and facilitate cross-study and cross-country comparisons. Future work will be required to update and expand on the range of services covered and to incorporate new data and methodological developments in cost estimation as they become available.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Jingjing Jiang
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute, London, SE5 9PJ, UK
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BA, Ireland
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Probst S, Bobbink P, Séchaud L, Buehrer Skinner M. Venous leg ulcer recurrences - The relationship to self-efficacy, social support and quality of life - A mixed method study. J Adv Nurs 2020; 77:367-375. [PMID: 33089585 DOI: 10.1111/jan.14611] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to explore the occurrence of venous leg ulcer recurrence and the relationship with self-efficacy, social support and quality of life. Furthermore, we investigated the lived experiences of those patients and their understanding of why they developed a recurrence. DESIGN We used a convergent parallel mixed method design consisting of a cohort and an interpretative phenomenological study arm. METHODS Consecutive patients (N = 145) were recruited into the study. Between 2014 and 2018, three primary care centres took part in the study. Data collection methods included chart review, administered questionnaires and semi-structured interviews. RESULTS The incidence of the venous leg ulcer recurrence was 33.1% within the study period. The scores for self-efficacy, social support and venous leg ulcer health-related quality of life show little variation between all measurement points and within subgroups. The qualitative findings identified two main themes: accidentally damaging the skin and avoiding venous leg ulcer recurrences. Venous leg ulcer recurrences frequently arose from accidents. Therefore, participants developed strategies to avoid additional ulcers. CONCLUSION To optimize recurrence prevention, improvements in knowledge of people with VLUs should be considered. IMPACT A mixed method, convergent, parallel design was used to explore the occurrence of venous leg ulcer recurrence and the relation of a venous leg ulcer recurrence with self-efficacy, social support and health-related quality of life. As well as the lived experiences of venous leg ulcer patients and why they developed a recurrence. The incidence of venous leg ulcer recurrences within the study period was 33.1%. Damaging the skin and avoiding a recurrence were the main identified themes.
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Affiliation(s)
- Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | - Paul Bobbink
- HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | - Laurence Séchaud
- HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva School of Health Sciences, Geneva, Switzerland
| | - Monika Buehrer Skinner
- Institute of Epidemiology, Biostatistics and Prevention, Director of Public Health Education Program, University of Zurich, Zurich, Switzerland
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Matter MT, Probst S, Läuchli S, Herrmann IK. Uniting Drug and Delivery: Metal Oxide Hybrid Nanotherapeutics for Skin Wound Care. Pharmaceutics 2020; 12:E780. [PMID: 32824470 PMCID: PMC7465174 DOI: 10.3390/pharmaceutics12080780] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Wound care and soft tissue repair have been a major human concern for millennia. Despite considerable advancements in standards of living and medical abilities, difficult-to-heal wounds remain a major burden for patients, clinicians and the healthcare system alike. Due to an aging population, the rise in chronic diseases such as vascular disease and diabetes, and the increased incidence of antibiotic resistance, the problem is set to worsen. The global wound care market is constantly evolving and expanding, and has yielded a plethora of potential solutions to treat poorly healing wounds. In ancient times, before such a market existed, metals and their ions were frequently used in wound care. In combination with plant extracts, they were used to accelerate the healing of burns, cuts and combat wounds. With the rise of organic chemistry and small molecule drugs and ointments, researchers lost their interest in inorganic materials. Only recently, the advent of nano-engineering has given us a toolbox to develop inorganic materials on a length-scale that is relevant to wound healing processes. The robustness of synthesis, as well as the stability and versatility of inorganic nanotherapeutics gives them potential advantages over small molecule drugs. Both bottom-up and top-down approaches have yielded functional inorganic nanomaterials, some of which unite the wound healing properties of two or more materials. Furthermore, these nanomaterials do not only serve as the active agent, but also as the delivery vehicle, and sometimes as a scaffold. This review article provides an overview of inorganic hybrid nanotherapeutics with promising properties for the wound care field. These therapeutics include combinations of different metals, metal oxides and metal ions. Their production, mechanism of action and applicability will be discussed in comparison to conventional wound healing products.
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Affiliation(s)
- Martin T. Matter
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland;
- Laboratory for Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Sebastian Probst
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206 Geneva, Switzerland;
| | - Severin Läuchli
- Department of Dermatology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland;
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering Laboratory, Institute of Energy and Process Engineering, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland;
- Laboratory for Particles-Biology Interactions, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
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Kelleher D, Barry L, McGowan B, Doherty E, Carey JJ, Kane D. Budget impact analysis of an early identification and referral model for diagnosing patients with suspected rheumatoid arthritis in Ireland. Rheumatol Adv Pract 2020; 4:rkaa059. [PMID: 33364546 PMCID: PMC7749785 DOI: 10.1093/rap/rkaa059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To estimate the budget impact from the perspective of the Irish health-care system attributable to a reconfiguration in the diagnostic care pathway for patients with suspected RA by adopting an early identification and referral model (EIM). Methods The budget impact model evaluated the total health-care use and costs attributable to an EIM to diagnose patients with suspected RA relative to the reference scenario of current practice. The modelling also assessed a primary outcome of effect, which examined how many patients can be diagnosed by a rheumatologist within 3 months of symptom onset. The budget impact analysis model was estimated over a 5-year time frame. Results The EIM generated a cost saving for the Irish health-care system of €237 547 over the time frame relative to current practice. The cost savings were realized owing to a reduction in the number of general practitioner (GP) visits of 18 790 and a reduction in diagnostic tests carried out by GPs. The results showed that 1027 (510%) more patients were diagnosed within 3 months of symptom onset in the EIM compared with current practice. Conclusion This paper has presented an alternative rheumatologist-led service design that can be used in diagnosing patients with suspected RA. The rheumatologist-led service provision detailed in this study has the potential simultaneously to reduce demand for primary care services and to improve the health outcomes of patients. The use of an EIM sees rheumatologist activity incorporate patient demand.
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Affiliation(s)
- Dan Kelleher
- Health Economics and Policy Analysis Centre, National University of Ireland, Galway, Galway, Ireland
| | - Luke Barry
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Bernie McGowan
- School of Medicine, National University of Ireland, Galway
| | - Edel Doherty
- Health Economics and Policy Analysis Centre, National University of Ireland, Galway, Galway, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway
| | - David Kane
- Department of Medicine (Rheumatology), Trinity College Dublin, Dublin, Ireland
- National Clinical Programme for Rheumatology, HSE, Ireland
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Effectiveness of implementation strategies for venous leg ulcer guidelines: A systematic review. J Tissue Viability 2020; 29:161-168. [PMID: 32340716 DOI: 10.1016/j.jtv.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/23/2020] [Accepted: 03/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of clinical practice guidelines (CPGs) is to improve patient care; however inconsistencies between recommended practice and what actually happens in clinical practice continues. Venous Leg Ulcers (VLUs) have a significant negative impact on patients' quality of life and it is acknowledged that managing people with venous leg ulcers is protracted and costly. The aim of this review is to identify the most effective strategies to implement clinical practice guidelines for the management of VLUs by health care professionals in the hospital, outpatient, home and community setting. METHODS A systematic review guided by methods from the Cochrane Effective Practice and Organisation of Care (EPOC) group was undertaken to identify implementation strategies for VLU clinical practice guidelines. Eligible studies were identified via systematic electronic searches of Medline, Embase, CINHAL and the Cochrane Library. RESULTS We identified 142 potential studies of which one randomised controlled trial met the inclusion criteria. Following an analysis of the included study, it is not possible to recommend one implementation strategy over another when implementing practice guidelines for people with VLUs. CONCLUSION We identified a limited evidence base for the effectiveness of implementation strategies for VLU CPGs. No one implementation strategy is better than another to facilitate VLU CPG implementation by health care professionals in hospital, outpatient, home or community settings.
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Public & patient involvement to guide research in wound care in an Irish context. A round table report. J Tissue Viability 2020; 29:7-11. [DOI: 10.1016/j.jtv.2019.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
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The lived experience of recurrence prevention in patients with venous leg ulcers: An interpretative phenomenological study. J Tissue Viability 2020; 29:176-179. [PMID: 31974010 DOI: 10.1016/j.jtv.2020.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/18/2019] [Accepted: 01/14/2020] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY To explore patient understanding of why they develop a venous leg ulcer and how they can prevent recurrence. METHOD The methodological framework of the hermeneutic phenomenological approach was used. Semi-structured interviews were conducted with seventeen participants living with a venous leg ulcer from May 2017 to November 2018. Data were analysed using Smith's interpretative hermeneutic analysis. RESULTS The results are categorised into three main themes: "Trauma due to accident" (initial venous leg ulcer) and "Prevention of ulcer recurrence" (compression); "Trauma due to compression therapy" (venous leg ulcer recurrence). The findings demonstrate active venous leg ulcers are often caused by acute incidents while carrying out an activity in people with underlying chronic venous insufficiency. After a complete healing, preventive measures, such a compression stockings are initiated by the patient or health care provider. Trauma due to adherence to compression stockings caused skin breakdown beneath compression that caused subsequent ulcer recurrence. CONCLUSION This study contributes to understanding the lived experience of patients with venous leg ulcers who develop a venous leg ulcer and their understanding of how they can prevent recurrence. Patients with VLUs would benefit from early preventive strategies, such as such a compression stockings fitting and application, integrated into daily care plan of primary care and community settings.
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Jayalakshmi MS, Thenmozhi P, Vijayaragavan R. Impact of chronic wound on quality of life among diabetic foot ulcer patients in a selected hospital of Guwahati, Assam, India. Ayu 2020; 41:19-23. [PMID: 34566380 PMCID: PMC8415236 DOI: 10.4103/ayu.ayu_33_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/31/2020] [Accepted: 02/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is an important mortality factor among diabetes mellitus (DM) patients and has a massive impact on the quality of life (QoL) of patients. The non-heal foot ulcer needs extra care and need special attention in maintaining wound hygiene. Dressing on wound is done in four stages such as cleanse the wound, debridement of wound, fashioning of edges and final dressing. The important stage of cleanse the wound was done with solution extracted from neem leaves which has medicinal value and anti-biotic properties and was used instead of normal saline or water solution, which do not carry medicinal value. Other medicinal solutions are of high cost as well as not easily available such as octanedione dihydrochloride or hypochlorous acid etc. AIMS This study was aimed to investigate the impact of DFU on QoL among patients suffering from chronic wounds. MATERIALS AND METHODS A cross-sectional, descriptive study was conducted at foot care clinic in a private hospital situated at Guwahati, Assam. Data were collected using a pro forma consisting of sociodemographic variables, Wagner ulcer classification and Cardiff wound impact questionnaire. Analysis of data was done using the descriptive and inferential statistical methods. RESULTS A total of 118 DFU patients of type 1 and 2 DM were studied. Out of which, 81.4% were male and 18.6% were female. About 66 participants (55.9%) were in grade 2 and 38 (32.2%) were in grade 3 of Wagner ulcer classification. Overall mean score for QoL was 6.27, whereas overall mean score for satisfaction on QoL was 7.01. Patients had the highest score in the well-being domain and lowest in the social life stress. Computation of correlation matrix and factor analysis showed a positive correlation between QoL and satisfaction and negative correlation between QoL and satisfaction with stressful experience of social life and physical symptoms experience (P < 0.05, 0.01). Multiple regression analysis reveals that satisfaction had a significant impact on QoL (P < 0.001) with r2 = 62.59%. Factor analysis of correlation matrix showed that physical symptoms and daily living experiences and social experiences as well as stress dominated factor 1 followed by satisfaction led QoL in factor 2 and social life stress was the leading force in factor 3. CONCLUSION QoL of patients with DFUs can be improved by educating the diabetic patients on the prevention and early detection of foot ulcers, other diabetic complications, and availing benefits of prevailing health-care facility in early stages.
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Affiliation(s)
| | - P Thenmozhi
- Department of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - R. Vijayaragavan
- Department of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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