Suzanne Kapp

A randomized‐controlled trial comparing cadexomer iodine and nanocrystalline silver on the healing of leg ulcers

Chronic leg ulcers are a debilitating, often painful, and costly condition. Leg ulcer healing may be impaired by bacterial colonization, which, unless effective intervention is instigated, can lead to infection. Although it is generally agreed that an antimicrobial dressing is clinically indicated when a wound becomes critically colonized, there is currently no agreement on what constitutes the best practice in the use of antimicrobials. This research compared the effectiveness of two commonly used antimicrobials: nanocrystalline silver and cadexomer iodine. A randomized‐controlled trial was conducted in which 281 community nursing clients with leg ulcers compromised by bacterial burden were randomly assigned to have their wounds treated with either silver or iodine dressings. Sixty‐four percent of ulcers healed within 12 weeks. The performance of each of the two antimicrobials was comparable in terms of overall healing rate and the number of wounds healed. However, use of silver compounds was associated with a quicker healing rate during the first 2 weeks of treatment and in wounds that were larger, older, and had more exudate. This trial provides some insights as to circumstances in which one product may be preferred over the other.

The Clinical Effectiveness of Two Compression Stocking Treatments on Venous Leg Ulcer Recurrence A Randomized Controlled Trial

Venous leg ulcers affect up to 3% of people aged 65 years and older, present significant pain and suffering, and are associated with long episodes of health care. These chronic wounds recur at rates of up to 69%. A double blind randomized controlled trial was conducted in a home nursing setting in Victoria, Australia to compare the effectiveness of a 23 to 32 mm Hg (moderate) and a 34 to 46 mm Hg (high) compression stocking treatment on venous ulcer recurrence. Participants (n = 100) were monitored for 26 weeks. Study wound recurrence was low (11.8%), and the average time to recurrence was 77.91 days. Adherence to treatment was low (44%) with nonadherence significantly higher in the high-compression stocking group, χ2(1) = 8.827, P = .003. Regression modeling found that adherence to treatment significantly predicted study wound recurrence, Wald(1) = 7.917, P = .005. Estimated hazard ratios showed that participants who did not adhere were 9 times more likely to have their wound recur. Risk of recurrence was 3 times greater for those randomized to moderate compression when compared with the high-compression stocking. Implementing strategies that optimize adherence to compression will reduce ulcer recurrence. Once this has been realized, the potential to adhere to high-compression treatment would further reduce the risk of recurrence.

Interrater and intrarater reliability of silhouette wound imaging device.

OBJECTIVE: The objective of this study was to investigate the interrater and intrarater reliability of a wound imaging and measurement system called SilhouetteMobile. DESIGN: Interrater and intrarater reliability study. SETTING: Community nursing, Victoria, Australia. PARTICIPANTS: Seven community nurses including Wound Management Clinical Nurse Consultants and Wound Resource Nurses. MAIN OUTCOME MEASURE: Average wound surface area of 14 wound images as captured using a wound imaging and measurement system called SilhouetteMobile. MAIN RESULTS: High interrater and intrarater reliability were maintained across different users and different assessments by the same user and were also found to be unaffected by image quality. Reliability was poor when tracing small wounds. CONCLUSION: Silhouette is a highly reliable tool for wound imaging and measurement, although reliability is reduced when annotating small wound areas.

The experience of self-management following venous leg ulcer healing.

AIMS AND OBJECTIVES The aim of the study was to explore the experiences of older people as they self-managed following venous leg ulcer healing. The objectives were to describe the beliefs, attitudes, actions, enablers and barriers to self-management and to consider the impact of an e-learning client education package on how people approach recurrence prevention. BACKGROUND Venous leg ulcers affect 1% of people worldwide and more than 3% of older people. Up to 70% of ulcers reoccur. Appreciation of the experience of self-management following healing can equip health services to more effectively prepare people for self-management in the longer term. DESIGN A descriptive exploratory design was used. METHODS Older people who had received an e-learning education programme while their venous ulcer was active were interviewed after healing from July-September 2010. Interviews were recorded, transcribed and thematically analysed. RESULTS Participants believed in the efficacy of compression therapy, skin care, activity and exercise and healthy eating to prevent recurrence, and engage in activities that reflect recommendations of the education. As beliefs and conduct of self-management activities can change over time, regular professional monitoring and support would assist people to refine health goals, plan self-management activities and prevent recurrence. CONCLUSIONS Participation in a standardised education programme completed prior to healing informed successful self-management strategies among people who seek to prevent venous leg ulcer recurrence. Further research should consider the benefits of regular, ongoing professional monitoring and support among this group. RELEVANCE TO CLINICAL PRACTICE Clinicians have a role in supporting their clients to know about, perform and believe in the importance of self-management strategies for healing and recurrence prevention. Clinicians require the capacity to support clients which standardised client education tools can facilitate.

Chronic wounds should be one of Australia's National Health Priority Areas

Chronic wounds are a poorly recognised chronic disease that cause pain and suffering and cost the Australian healthcare system A

Examining factors that influence the adoption of health-promoting behaviours among people with venous disease

2.85 billion dollars per annum. Unlike the highly profiled and relatively well-funded chronic diseases that comprise the Australian National Health Priority Areas, chronic wounds remain a largely hidden and poorly supported problem in the Australian community. This perspective article proposes that one approach to generate action to reduce the burden of chronic wounds is to better articulate the relationship between chronic wounds and the Australian National Health Priority Areas, and to establish a profile of chronic wounds as a chronic disease of national significance in its own right. This approach has the potential to raise awareness of the significance of chronic wounds and garner support from the public, healthcare sector, research funders and policy makers to improve the outcomes for people who are living with or at risk of developing this condition and to potentially reduce expenditure in this area.

The financial and quality-of-life cost to patients living with a chronic wound in the community

People living with venous disease are encouraged to make a number of behaviour modifications to facilitate healing and to prevent a recurrence of a venous leg ulcer. This investigation sought to examine factors described in the literature that shape the effectiveness of multi‐component education programs and conduct a secondary analysis of data to examine relationships between various health behaviours for people with a venous leg ulcer who participated in a standardised e‐learning education program. This study found few statistically significant and typically minor relationships between health behaviours after participants had completed the education program. No significant differences were identified by participant gender, age or need for a carer, for either the number of health behaviours performed after the education or the number of behaviour changes made during the education. Participants performing few of the recommended health‐promoting behaviours prior to the education achieved more behaviour change than those already engaged in the sought after activities [F(2,154) = 16·038, P = 0·000]. The notable lack of associations between the performance of the health‐promoting behaviours places emphasis on the need for comprehensive investigation of the moderators and mediators of multi‐faceted behaviour change to promote wound healing and chronic disease management.

Telewound care - providing remote wound assessment and treatment in the home care setting: current status and future directions

Chronic wounds are associated with financial and personal costs. The system level expense associated with chronic wounds has been established, however, the out‐of‐pocket cost incurred by individuals who self‐fund has not been the focus of extensive investigation. Recently, there has been renewed interest in evaluating quality of life, in line with the shift to patient enablement and self‐care in chronic disease management.

Informal carers and wound management: an integrative literature review

The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home.

Sustaining Behavior Changes Following a Venous Leg Ulcer Client Education Program

OBJECTIVE The consequences of informal care giving have been well documented in recent decades, and in many fields of illness and chronic disease, the role of informal carers has been recognised and investigated. Informal caregivers in the field of wound management and prevention have been largely unnoticed, despite the chronic nature of many wounds, the enduring nature of treatments and the impact on the physical and social environment; factors likely to have a significant impact on family and friends. The aim of this study was to consider what published evidence is available regarding the experience and role of informal caregivers in wound management or prevention. METHOD An integrated literature review was completed in October 2014 searching ESBCOhost database, Wound Management Association websites, and reviewing reference lists of accessed papers. RESULTS A number of challenges were noted in accessing information about informal carers in relation to wound management and prevention. Most of these arose from the scarcity of studies for which informal carers was the primary focus. The available evidence suggests that informal carers have a role in wound management and prevention and that their involvement is likely to represent a noteworthy economic contribution to the wound management health-care team. Wound management was also determined to yield physical and psychological impacts for the carer. There was limited evidence of structured information, support or training for informal carers, which was flagged by carers as an area of need. CONCLUSION General conclusions about the burdensome experience and the valuable role of carers were the main interpretations possible from the evidence. More research which purposively and comprehensively examines the experience and role of informal caregivers is required. This knowledge would provide a foundation upon which interventions and support for informal carers and patients can be generated, which could further serve to enhance wound healing and the prevention of skin damage.