Heather L. Orsted

A dressing history

Over the past 30 years as caregivers, clinicians have been exposed to a plethora of new advanced wound dressings. The moist wound care revolution began in the 1970s with the introduction of film and hydrocolloid dressings, and today these are the traditional types of dressings of the advanced dressing categories. Wound‐healing science has progressed significantly over the same period, as a result of intense clinical and scientific research around these product introductions. Today, the clinician understands moist wound healing, occlusion, cost effectiveness, wound bed preparation and MMP activity to name but a few of the many concepts in wound care that have flourished as a result of technology and product advancement. This review article presents a condensed history of dressing development over the past 30 years. However, in addition, such advancement is discussed in respect to its adoption in different parts of the world. The largest single markets of the world are generally the United States of America and Europe; as such, the development of both practice and technology generally begins there. Much has been written about these markets in previous review articles. For the purposes of this review, the development of wound care and the maturing of practice is discussed in respect to Canada, Japan and Australia representing smaller geographical areas where the development has been more recent but nonetheless significant.

Dilemmas in measuring and using pressure ulcer prevalence and incidence: an international consensus

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The groups main findings are summarised in this paper.

A prospective, randomized, multisite clinical evaluation of a transparent absorbent acrylic dressing and a hydrocolloid dressing in the management of Stage II and shallow Stage III pressure ulcers.

OBJECTIVE: To compare clinical performance of a transparent absorbent acrylic dressing (3M Tegaderm Absorbent Clear Acrylic Dressing ]TAAD[; 3M Company, St Paul, MN) and a hydrocolloid dressing (HD ]DuoDERM CGF, ConvaTec, ER Squibb & Sons, Princeton, NJ[) in the management of Stage II and shallow Stage III pressure ulcers. DESIGN: Prospective, open-label, randomized, comparative, multisite clinical evaluation. Patients were followed up for a maximum of 56 days or until their ulcer healed. At weekly intervals, investigators conducted wound assessments and dressing performance evaluations. SETTING: Wound care clinics, home care, and long-term care. PATIENTS: Thirty-five patients received the TAAD, and 37 received the HD. OUTCOME MEASURES: Dressing performance assessments, patient comfort, dressing wear time, and wound healing were measured. RESULTS: The majority of investigator assessments favored the TAAD. Considerations given included the ability to center dressings over the ulcer (P = .005), ability to assess the ulcer before (P < .001) and after (P < .001) absorption, barrier properties (P = .039), patient comfort during removal (P < .001), overall patient comfort (P = .048), conformability before (P = .026) and after (P = .001) absorption, ease of removal (P < .001), nonadherence to wound bed (P < .001), residue in the wound (P = .002), residue on periwound skin (P < .001), and odor after absorption (P = .016). Overall satisfaction favored the TAAD (P < .001), and a high value was placed on its transparent feature (P < .001). Mean (SD) wear time for the TAAD was 5.7 (2.55) days compared with 4.7 (2.29) days for the HD (P = .086). This 1-day difference in wear time was clinically noticeable by the investigators (P = .035). Wound closure for the 2 dressing groups was nearly identical (P = .9627). CONCLUSIONS: Performance results favored the TAAD over the HD as standard treatment for Stage II and shallow Stage III pressure ulcers.

Evidence‐based practice standards for the use of topical pressurised oxygen therapy

Whenever a new therapy enters the wound care arena it is mandatory to deliver the best evidence to clinicians, healthcare administrators and policy makers to support integration of the technology into clinical practice. While this can often be problematic when novel therapies lack a large body of supporting evidence, methods that incorporate the use of expert opinion do exist to evaluate existing evidence and create consensus statements that can help guide decisions. Topical pressurised oxygen therapy is a method of delivering pressurised and humidified oxygen directly to the wound bed to support the healing of chronic and hypoxic wounds. This article will present the process by which the evidence was identified and evaluated as well as present standards based on the evidence related to topical pressurised oxygen therapy. We will show, through the use of the evidence, how this therapy can be a non invasive safe approach for wound management for selected patients in all clinical care settings.

Reimbursement of dressings: a WUWHS Statement

INTRODUCTION The treatment of wounds has undergone a technical revolution since the pioneering work on moist wound healing by Winter in 1962. Since that time, a number of different classes of wound dressings and devices have been developed, facilitating patient comfort, optimising local wound management and improving the outcome of care. More complex wounds can be treated earlier, with improved outcomes, as demonstrated by a fall in the rate of amputations associated with diabetic neurotrophic foot ulcers. However, most of modern dressings and devices have not yet brought about a significant level of improvement in wound healing or patient care. The problem arises with regard to the method of approval of dressings and devices in many countries, where statisticians working for country-specific health authorities require evidence from randomised clinical trials. These randomised clinical trials should reflect the efficacy and efficiency of devices while taking into account the multifactorial nature of many chronic wounds and associated comorbidities. Currently, the only gold standard criterion used by health authorities to assess different devices is complete wound healing. However, some countries – influenced by panels of experts – may adopt another strategy for reimbursement, based on what are known as ‘secondary’ criteria or surrogate endpoints. Some of these alternative endpoints are adapted in peer-reviewed published studies and include an improvement in pain or other quality-of-life indicator, an improvement in wound surface debris, a 4-week reduction of at least 30% from baseline in wound size and an increased presence of healthy granulation tissue in the wound base. The World Union of Wound Healing Societies (WUWHS) panel members are advocating for a minimal set of reimbursed devices in all countries worldwide. It is currently acknowledged that reimbursement exists for dressings and devices in a limited number of geographical areas, whereas in other countries, no reimbursement is available or partial coverage may disadvantage outpatients. Education is another important component to improve patient outcomes. Teaching of the basic principles of wound management including evidence-based treatment of the cause and how to manage patient needs should be offered as tools for changing practices. An International Consensus approach was investigated during the first and second WUWHS reimbursement in Paris in 2005 and 2006, leading to this statement.

The International Interdisciplinary Wound Care Course at the University of Toronto: a 4-year evolution.

The International Interdisciplinary Wound Care Course at the University of Toronto was designed to emphasise interdisciplinary collaboration, examine the evidence base and develop wound care opinion leaders across Canada and internationally. There is a need to translate the new wound care evidence base for diagnosis and treatment into patient care and ultimately improve patient outcomes.

The Wound CARE Instrument: the process for developing standards for wound management education and programming.

This article describes the collaborative process undertaken by the Canadian Association for Enterostomal Therapy and the Canadian Association of Wound Care in an effort to improve the quality of wound prevention and management education and programming. The end result of this process is the Wound CARE Instrument which promotes an interprofessional, collaborative appraisal process to support the development, adoption or adaption of wound management educational events and programs.

Third Congress of the WUWHS

We have been invited by the Editors of the International Wound Journal to provide an editorial in preparation for Congress 2008. As the Chair and Co-Chairs of the congress we are delighted that the IWJ chose to add an additional copy of the journal in support of the many initiatives of the congress. We are also pleased that the cover of the Journal was changed to red, the conference colour, to recognize the importance of our Congress. Firstly let us provide a warm welcome to all readers who will shortly be in Toronto. And to all of you unable to attend – we will miss you! Much activity has taken place in the past 4 years and in particular the past few months to get prepared for the congress. To all involved we thank you and look forward to an exciting event, meeting old friends and a well deserved holiday post congress. The third meeting of the World Union of Wound Healing Societies is truly a partnership between the University of Toronto, Women’s College Hospital, wound care associations and wound care publishers. Industry has contributed significantly through unrestricted educational grants. As individuals, we all participate in the creation and dissemination of wound care knowledge. We all share the common problem of preventing and treating wounds. Collaboratively, we can provide a unified voice for the development of wound care as a clinical multiprofessional specialty. That is ‘One Problem – One Voice’. Congress 2008 provides a forum for the dissemination of evidence informed practice on a global basis. Through the efforts of many of the participating organizations the World Union has initiated the collection, review and dissemination of the evidence base for wound care on an international basis. The primary goal of Congress 2008 and the World Union of Wound Healing Societies is to present the wound care evidence base, provide expert knowledge and transfer the knowledge, skills, and attitudes for improved patient outcomes. Included will be the alignment of evidence-based medicine to ‘‘Evidence Informed Transdisciplinary Practice’’ that fits the clinical needs of practitioners caring for persons with wounds. Treating acute and chronic wounds is an ongoing challenge for health care professionals in all parts of the world. Social, economic and technological differences, however, can create a vast divide in global approaches to wound care. Congress 2008 embraces the multicultural, multidisciplinary nature of its audience and provides an opportunity not only to network but also to work together for the benefit of all wound healers on a global basis. This will be accomplished through a preconference day, four plenary presentations, and 10 concurrent streams with 100 educational sessions, a summary of which is presented in this Congress edition. For the last three years, we have been working on a web-based initiative to link wound care evidence and expert knowledge. The website will be presented in a ‘just in time’ format for improved patient care. The evidence summaries created will also be presented to each delegate on Sunday in the form of a CD. They will also be freely accessible on the website (WoundPedia). This is not a one-time effort, but a continued collaboration of the World Union and our partners. Under the stewardship of Professor R. Gary Sibbald, during his tenure as President, the initiative will be a legacy of the WUWHS. This is not the end, merely the beginning! EDITORIAL