Sebastian Probst

Malignant fungating wounds: a survey of nurses' clinical practice in Switzerland.

BACKGROUND The care of individuals with a fungating malignant wound represents challenging cancer management not only for patients and their families but also for health care professionals. Understanding the difficulties faced by nurses when they care for patients with such a wound can help guide practice and service development. The aim of this study was to investigate how many patients with a malignant fungating wounds did nurses see and what kind of difficulties in caring for patients with a malignant fungating wound did nurses experience. METHOD A survey was conducted in three different geographical regions of Switzerland over a 6month period. RESULTS A total of 269 nurses participated in this survey. The nurses reported the prevalence rate of fungating wounds as 6.6%. There was a difference in perceived prevalence between the regions. The most frequent location for such wounds was the breast in women with breast cancer. The appearance was mainly ulcerating. The main difficulties nurses experienced in the management of patients related to malodour, pain and difficulties in applying the dressings to the wound. The most frequently used dressing was an absorbent dressing. The difficulties nurses had and what kind of dressings they used were closely connected. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Strategies need to be explored to help understand the diverse range of wound problems including physical and psychological components. Furthermore, there is a need to raise the awareness of existing wound management specialists in the support of cancer patients.

Malignant fungating wounds – The meaning of living in an unbounded body

BACKGROUND Malignant fungating wounds may have significant physiological, psychological and emotional consequences on patients and their families. This study focuses on understanding the lived experiences of patients with a malignant fungating breast wound and their informal carers. METHOD The methodological framework of interpretative phenomenological approach according to Heidegger was used. Nine patients were interviewed from January until November 2009. RESULTS The results demonstrate that most of the patients and their informal carers were on their own while struggling with the erosion of their physical boundaries. The women report a lack of information and advice about how to manage the wound as well as the physical and social limitations imposed on them because of copious wound exudate, odour and bleeding. The women used many different methods and approaches to maintain the boundedness of the body. CONCLUSION This study contributes to understanding that losing control over the body meant for the women losing control over themselves and their lives. The unboundedness was demonstrated through the symptom experiences. Therefore the care of women needs strategies that are integrated in a palliative, holistic, empathic approach. In particular skills for palliative wound care among medical and nursing staff need to be developed as the women and their carers report a lack of information and advice about how to manage the wound as well as the physical limitations and psychosocial consequences of struggling to maintain the boundedness of the body.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).

Kompressionstherapie bei Patienten mit Ulcus cruris venosum

Wund‐D.A.CH. ist der Dachverband deutschsprachiger Fachgesellschaften, die sich mit den Thematiken der Wundbehandlung beschäftigen. Experten verschiedener Fachgesellschaften aus Deutschland, Österreich und der Schweiz haben nun einen aktuellen Konsens der Kompressionstherapie für Patienten mit Ulcus cruris venosum erstellt.

How are topical opioids used to manage painful cutaneous lesions in palliative care?: A critical review

0304-3959/

Compression therapy in patients with venous leg ulcers

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Caring for a loved one with a malignant fungating wound.

Wund‐D.A.CH. is the umbrella organization of the various wound care societies in German‐speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland.

Malignant wound management in advanced illness: new insights

PurposeCaring for a loved one with a malignant fungating wound is very challenging and causes extreme physical and psychological distress. The aim of this study was to explore the experiences of carers who care for a loved one with a fungating breast wound.MethodTo explore the lived experiences of carers, a methodological framework using Heideggerian hermeneutic phenomenology and semi-structured interviews was used. Seven carers were interviewed from January until November 2009.ResultsHaving to deal with a situation of a loved one with a visible cancer was hard for all the carers. The visibility of the cancer was one of the most shocking aspects to deal with from the perspective of the patient and the carer. The presence of the visible wound and a cancer at an advanced stage contributed to a change in the relationship and extreme suffering for both the patient and the carer. Despite many problems such as wound odour and copious discharge from the wound, which was difficult to control, carers did their best to help their loved one with the wound. Gradually, the wound became the centre of the patient and carer’s life, and a great deal of time was spent trying to control the wound symptoms. All carers managed the wound on their own without help and advice from health care practitioners. For all of them, it was a major burden and they felt isolated.ConclusionThis study contributes to an understanding that the care of women and their carers needs strategies that are integrated in palliative wound care that takes a holistic and empathic approach that responds to patients’ and carers’ psychosocial and emotional needs and a practical need for information to help carers assist in managing the wound-related symptoms.

M.O.I.S.T. – ein Konzept für die Lokaltherapie chronischer Wunden

Purpose of reviewThis article describes why this review is timely and relevant. To report on the recent research, which advances our understanding and practice of palliative wound care (wound-related pain and symptom management or wound palliation). Recent findingsThis article describes the main themes in the literature covered by the article. The main themes include the problem of malodour and the palliative management of cutaneous and subcutaneous malignancy of skin and nonskin origins. The findings from an international survey of measures to combat wound malodour are reported, which indicate that malodour is one of the most distressing and difficult to manage symptoms associated with malignant wounds. A relatively novel palliative treatment for cutaneous malignancy, electrochemotherapy, is outlined, together with the growing evidence supporting its use. SummaryThis article describes the implications of the findings for clinical practice or research. The findings of the wound malodour survey indicate that approaches to managing malodour are wide ranging, but ineffective. Collaborate research and development is needed with industry into interventions to combat malodour, which are based on the causal agents. The growing evidence of the effectiveness of electrochemotherapy, as an uncomplicated palliative treatment and method of managing symptoms, offers palliative care clinicians a means of managing the otherwise relentless progression of cutaneous malignancy.

Antimicrobials and Non-Healing Wounds. Evidence, controversies and suggestions—key messages

Wunden werden als chronisch bezeichnet, wenn diese nach acht Wochen nicht abgeheilt sind [ 1 ] . Unabhängig von dieser zeitlich orientierten Defi nition werden Wunden von Beginn an als chronisch eingestuft, wenn ihre Behandlung eine Therapie der weiterhin bestehenden Ursache erfordert. Hierzu gehören beispielsweise das diabetische Fußulkus, Wunden bei pAVK, Ulcus cruris venosum oder Dekubitus. Die Grundlage der erfolgreichen Therapie chronischer Wunden basiert auf der Diagnostik [ 2 ] und der kausal ansetzenden Behandlung der zugrundeliegenden, pathophysiologisch relevanten Erkrankungen [ 3 ] unter Einbezug relevanter psychosozialer Faktoren [ 4 ] . Begleitend hierzu sollte bei den meisten Patienten auch eine an den Phasen der Wundheilung orientierte, feuchte Wundtherapie durchgeführt werden [ 5 ] . Metaanalysen belegen, dass der Einsatz einer solchen modernen Wundtherapie die Abheilungsraten chronischer Wunden unterstützt [ 6 ] . Die aktuell hierfür zur Verfügung stehenden Therapieoptionen sind sehr vielfältig, so dass es vielen Therapeuten schwer fällt, einen Überblick zu bewahren. In den letzten Jahren wurden bereits verschiedene Akronyme vorgestellt, die eine Hilfe bei der Strukturierung der Lokaltherapie chronischer Wunden darstellen sollten. International hat sicher das 2003 erstmalig publizierte T.I.M.E.-Konzept die weiteste Verbreitung gefunden. In den letzten mehr als zehn Jahren haben sich allerdings viele neue Aspekte und Therapieoptionen ergeben. Es war daher das Ziel einer interdisziplinären und interprofessionellen Expertengruppe für Wund-D.A.CH., dem Dachverband der deutschsprachigen Fachgesellschaften im Wundheilungssektor, das bewährte T.I.M.E.-Konzept für die Systematik der Lokaltherapie chronischer Wunden weiterzuentwickeln, um auch aktuelle Optionen hierbei einbeziehen zu können. Die mit „T“, „I“ und „M“ beschriebenen Faktoren des T.I.M.E.-Konzepts sind weiterhin zeitgemäß und wichtig. Sie wurden daher leicht modifi ziert für das neu entwickelte M.O.I.S.T.-Konzept übernommen (Tabelle 1 ). Mit dem Buchstaben „E“ wurde bei T.I.M.E. ursprünglich epidermis [ 7 ] Clinical Letter