New articles published by the Journal of Wound Management

   

Healthcare practitioners’ views on the assessment and management of pain in chronic lower limb wounds

Authors: Nicoletta Frescos, William McGuiness 

DOI: 10.35279/jowm202110.02

First published 4 October 2021

This article should be referenced as: Fresco N, McGuiness W: Healthcare practitioners’ views on the assessment and management of pain in chronic lower limb wounds, Journal of Wound Management, 2021


ABSTRACT
Wound-related pain in people with chronic lower limb wounds is often underestimated and undertreated by clinicians. This paper provides an overview of the findings from a mixed methods study exploring the perceptions and experiences of healthcare practitioners (HCP) on the assessment and management of wound-related pain, in an effort to provide insights into the above deficit.
Aim
The aim of this study was to explore whether assessments of wound pain are undertaken and what the barriers are to wound pain anagement, from the perspectives of HCP.
Method
This study encompassed two research activities (an HCP survey and focus groups). An explanatory, sequential mixed method design combining data from the survey and the focus groups was used for the study.
Results
At present, there is no consistent method for the assessment and management of wound-related pain. The key barriers to effective management of pain identified here are pain language, the attitudes and beliefs of HCP in relation to pain assessment and a lack of knowledge and skills in evidence-based practice in wound-related pain.
Conclusion
There is a need for a universal clinical multidimensional wound pain assessment tool that incorporates clinical guidelines and prescriptive pathways for managing wound-related pain.


Protecting patients’ skin during prone ventilation - the PRONEtect practice guidance document

Authors: Anika Fourie, Dimitri Beeckman

DOI: 10.35279/jowm202107.05

First published 5 July 2021

This article should be referenced as: Fourie A, Beeckman D: Protecting patients’ skin during prone ventilation - the PRONEtect practice guidance document, Journal of Wound Management, 2021


ABSTRACT
Background: 
Ventilating the critically ill patient with acute respiratory distress syndrome in the prone position is a lifesaving strategy, but it is coupled with adverse consequences such as the development of pressure ulcers.
Aim: To develop evidence-based recommendations for critical care clinicians in a concise, simple and visual practice guidance document.
Methods: A gap analysis study conducted by the Skin Integrity Research Group and the Swedish Centre for Skin and Wound Research (currently submitted to a peer-reviewed international journal) formed the basis for the practice guidance document. The gap analysis study reviewed which guidelines, equipment/devices and other digital resources were available during a systemic, comprehensive literature and digital search conducted between August and November 2020. An international expert panel reviewed the identified gaps and provided their feedback. The information from the comprehensive search provided the foundation for the design of the practice guidance document.
Findings: The “PRONEtect (Prone & Protect) practice guidance document – skin care considerations for the patient in the prone position” was developed by the research team, reviewed and approved by the expert panel and then launched on public platforms in December 2020.
Conclusions: The PRONEtect document’s recommendations could assist clinicians in reviewing key considerations for tissue damage prevention in patients in the prone position.
Implications for clinical practice: To date, the document has been translated into eight languages, and some critical care units have updated their prone protocols according data presented in this document. This will be a dynamic document and revised as more evidence-based practices and technologies become available, specifically for prone ventilation and the prevention of tissue damage.


Do personality and mood difficulties predict foot self-care in diabetes?

Authors: Peter Thomas Murphy, Aaron Liew, Brian E. McGuire, John Bogue, Monika Pilch, Sean Dinneen, Aonghus O’Loughlin, Anne Doherty, & Sínead Conneely

DOI: 10.35279/jowm202107.06

First published 1 July 2021

This article should be referenced as: Murphy PT, Liew A, McGuire BE, Bogue J, Pilch M, Dinneen S, O’Loughlin A, Doherty A, Conneely S: Do personality and mood difficulties predict foot self-care in diabetes?, Journal of Wound Management, 2021


ABSTRACT
Background: The literature indicates the impact of psychological factors on the development and course of diabetes remains unclear.
Aim: To explore personality, depression, diabetes-related distress and illness beliefs in adults attending routine diabetes clinics and investigate whether the extent of these difficulties can predict foot self-care.
Methods: Participants were consecutive patients with diabetes attending diabetes outpatient and podiatry clinics in hospitals who completed self-administered questionnaires to access personality traits and evaluate them for personality disorders, depression, diabetes-related distress, beliefs about illness and foot self-care.
Results: Approximately 1 in 5 participants screened positive for Type D personality, personality disorders and diabetic-related distress; 8% screened positive for major depression. A standard multiple regression model determined whether foot self-care was predicted by these variables. The results were non-significant, F (13, 106) = 1.63, p = .09. Having macrovascular complications was significantly positively related to foot self-care (r(118) = .20, p = .027). Participants with a current and/or past history of DFU had higher BMI, longer duration of diabetes, were more likely to be on insulin therapy and to have concomitant microvascular complications.
Conclusion: Personality and mood disorders are prevalent in people attending diabetes clinics, but the variables measured here do not predict foot self-care.
Implications for clinical practice: Adults attending specialist podiatry/diabetes clinics need clinical pathways to mental health support.


The HERMES Study – blue ligHt photobiomodulation thErapy on neuRoischeMic patiEntS – Experimental Design and Study Protocol

Authors: Alberto Piaggesi, Alessia Scatena, Sara Sandroni and Stefano Gasperini

DOI: 10.35279/jowm202107.07

First published 29 June 2021

This article should be referenced as: Piaggesi A, Scatena A, Sandroni S, Gasperini S: The HERMES Study – blue ligHt photobiomodulation thErapy on neuRoischeMic patiEntS – Experimental Design and Study Protocol, Journal of Wound Management, 2021


ABSTRACT
Aims: To evaluate the safety and effectiveness of photobiomodulation1 therapy in addition to the standard of care (SoC) for managing diabetic foot ulceration (DFU), we designed a prospective randomised double-blind trial for neuro-ischemic patients (HERMES study), whose design and study protocol we describe in this paper.
Patients and methods: All patients with a chronic neuro-ischemic DFU wider than 1 cm2 attending the S. Donato Hospital DF Clinic in Arezzo, Italy (I), will be screened for enrolment. After two weeks, while patients are treated with SoC, those whose lesions have not decreased by 50% or more in size will be randomised into two groups: the control group will be managed with SoC, while the study group will be treated with photobiomodulation + SoC twice weekly for 20 weeks, or until healing. Both groups will be managed in the community by visiting nurses. The outcomes [healing rates at 24 weeks (primary endpoint), healing times, speed of area reduction, pain, quality of life, adverse events] will be blinded to the treatment.
Results: As a pilot study, we cannot anticipate results, but we expect a positive difference of at least 15% in the study group’s primary outcomes, compared to controls, with no worsened safety profile.
Conclusions and implications for clinical practice: The interest of the HERMES study, beyond the findings related to the efficacy and safety of photobiomodulation, lies in the characteristics of this low-cost, no-waste technology and its integration in specialist and community-based care.


Negative pressure wound therapy and patients with severe diabetic foot ulcers: A retrospective cohort study

Authors: Rashad A. Bishara, Amr M. Abdel-Mawgoud, Laila Al-Sabbagh, Ihab N. Hanna, Mohammed Ramadan Abdel-Mageed, Nehad A. Fouad, Ramez O. Shehata

DOI: 10.35279/jowm202107.03

First published 26 June

This article should be referenced as: Bishara RA, Abdel-Mawgoud AM, Al-Sabbagh L, Hanna IN, Abdel-Mageed MR, Fouad NA, Shehata RO: Health belief theories and their influence on adherence behaviours in individuals with diabetic foot ulceration: A literature review, Journal of Wound Management, 2021


Aim of the study: This study aimed to compare the results after using NPWT to standard wound care in severe DFUs, classified in the WIFI classification system as W2 and W3.


How to integrate new technologies into daily practice: The clinician perspective

Authors: Luc Téot, Sylvie Meaume

DOI: 10.35279/jowm202107.02

First published 21 June 2021

This article should be referenced as: Téot L, Meaume S: How to integrate new technologies into daily practice: The clinician perspective. Journal of Wound Management, 2021


ABSTRACT
Background: The integration of new technologies can call for obeying different rules and should be considered a long-term evolutionary process that is realised step by step. Before a medical device appears in the market, a long regulatory process has been completed, including safety, experimental and preclinical studies leading to an authorisation for distribution in a national market. Depending on the target countries and their respective regulations, the need for robust clinical studies, including randomised clinical trials, is often mandatory for distribution. Post-clinical trials may be used to confirm the results obtained from a medical device. The efficacy of the introduction of new technology in daily practice is then dependent on clinicians’ perceptions of the improvement in wound-healing. Complications may occur even after a long period of time, with severe consequences for patients’ quality of life. Since the PIP (Poly Implant Prothèse) scandal, more restrictions have been imposed to prevent such failures and increase the safety for the population.


Health belief theories and their influence on adherence behaviours in individuals with diabetic foot ulceration: A literature review

Authors:  Nurul Z, Holloway S, Edney SM

DOI: 10.35279/jowm202107.03

First published 17 June 2021

This article should be referenced as: Nurul Z, Holloway S, Edney SM: Health belief theories and their influence on adherence behaviours in individuals with diabetic foot ulceration: A literature review, Journal of Wound Management, 2021


ABSTRACT
Background: Existing evidence suggests that adherence to treat­ment plans and long-term lifestyle modifications could reduce costly complications associated with diabetes, such as diabetic foot ulcers (DFU). Apply­ing biopsychosocial models and theories to practice can help clinicians understand why individuals adopt or reject certain health behaviours.

Aims: This review explores the dynamic between patients’ psychosocial behaviours and their levels of commitment to treatment plans, discusses approaches for improving the therapeutic relationship between health care professionals (HCPs) and patients through collaborative healthcare planning and raises awareness of the importance of identifying the psychological barriers to managing outcomes of chronic illnesses.

Methods: This is a narrative exploration of health belief theories applied to managing diabetes and DFU, including a discussion of ‘compliance’, ‘adherence’ and ‘con­cordance’; health psychology theories on adherence behaviours; and the role of emotional responses in influencing the acceptance of long-term treatments.

Findings: Evidence highlighted the role of psychosocial factors in influencing a person’s decision-making process and noted individual differences in the willingness to conform to certain health and treatment recom­mendations, based on prior assumptions and know-ledge extending beyond a longer-term conception of the benefits and risks of behaviours or disease progression.

Conclusions: Healthcare planning should shift from labelling patients as ‘non-compliant’ toward promoting collaborative conversations that inform choices and actions. HCPs should acknowledge the im­portance of patients’ knowledge and views about their health and create treatment plans that best suit these individual needs. Future research should develop health belief models to incorporate pa­tients’ emotional responses to chronic illness.