Dear members and colleagues,
At the recent meeting in Galway it was great to see so many enthusiastic colleagues in wound care, industry representatives and practitioners all working together to improve the quality of wound care in Ireland. But how can we ensure that this continues in the current climate of harsh cutbacks?
WMAI plays an important role in providing education and updates locally to wound care practitioners. These sessions have always been well attended with positive feedback but I feel that WMAI has the potential to make a huge difference in teaching practitioners how to critique research. By using all levels of evidence from lab studies to randomised control trials WMAI could help practitioners to hone their skills in evaluating the strengths and weaknesses of various study designs. It is only by demonstrating evidence based research that business managers will listen and provide resources where most needed.
Appraising the literature can be a challenge. Many studies are difficult to interpret and sometimes it’s difficult to understand which outcomes are being explored. But I think a more proactive approach is necessary and could be rewarding. By challenging and discussing the potential merits of recent studies we can build on the bank of evidence we have. Whether it’s through workshops or tutorials WMAI in collaboration with industry can help practitioners to appraise the research and identify when the findings might be applied to improve patient outcomes.
The WMAI is an active organization going from strength to strength. Working together we have the will and the expertise to lead research and education in wound management and tissue viability in Ireland. In 2012 the WMAI in collaboration with the HSE, RCSI and industry can synergistically develop wound research ideas and gather data that could potentially impact greatly on the future care of our patients and our service delivery. Our members are very important to us and we value your support to date and look forward to further cooperation into the future.
I would like to take this opportunity to wish all our members and colleagues a Happy new year
15th Anniversary Conference of Wound Management Association of Ireland.
Dr. Georgina Gethin, Chairperson Scientific Organising Committee and immediate past-president Wound Management Association of Ireland
In October 2011, the WMAI held its 15th anniversary conference in the beautiful but windy city of Galway on the West coast of Ireland. Despite the challenges faced by many in the current economic climate this conference was the biggest and one of the most successful to date. Over 300 delegates from nine countries attended over the two days.
The theme was, Building the Future of Wound Care, and the key note address on day one, delivered by Prof. Keith Harding, certainly focused minds on what has been achieved to date but also on the challenges ahead. Prof. Harding made particular reference to the importance of the multi-disciplinary team as it is only through such sharing of ideas, knowledge and experience can we really build the future and advance our understanding of wound healing. Further presentations by Prof David Gray discussed the management of complex wounds and the development of remote monitoring of wounds through the process of tele-medicine.
Pain is a major issue in wound healing, whether it is the acute traumatic wound or the chronic leg ulcer. Dr. Brian McGuire of NUI Galway discussed the physiology of pain and mechanisms which clinicians can use to assess pain and indeed help the patient to cope with pain.
Conferences such as the WMAI actively promote the engagement of the novice practitioner and this conference encouraged the participation of a range of disciplines across a range of workshops. Delegates attended workshops on wound assessment, documentation, repositioning, gait assessment, assessment of the diabetic foot, vascular assessment, debridement, bandaging and compression. These were delivered by a range of experts in the field including; Sinead Murphy, Marion Cahill-Collins, David Watterson, Kate Arkley, Mary Burke, Zena Moore, Julie Jordan-O’Brien, Adelene Greene and Caroline McIntosh. The only criticism of the workshops was that there was not enough time and delegates have requested more workshops in the future.
An interesting feature of the WMAI conference is the panel discussion. This year the topic was: Technology versus dressings in wound management – is there a difference in outcomes? The session was chaired by Dr. Georgina Gethin and panel members included Mr. Henry James, Dr. Zena Moore, Prof. Raj Mani and Ms. Susan Mendez-Eastman. While the role of technology in wound management was discussed, the panel and delegates reiterated the need for appropriate assessment of the patient and their wound and emphasised that in the absence of a comprehensive assessment appropriate management cannot advance.
On day two, the conference held the first of the concurrent sessions. Palliative wound care was presented by two experts in the area including Dr. Patricia Grocott and Dr. Sebastian Probst. The concept of the ‘unbounded body’ and the need to develop dressings to fit the complex needs of patients with palliative wounds were well articulated by both presenters. There is a need to build a core body of knowledge in palliative wound care which can support the individual and the clinician. Four presenters discussed the current advancements in wound diagnostics and the micro environment of the wound. These included Prof. Sean Tierney, Prof. Raj Mani, Prof. Robert Strohal and Dr. Georgina Gethin. Delegates heard presentations on the WAR assessment tool for assessment of wound infection risk and the role of pH in wound bed assessment. Later that morning Dr. Breda Cullen introduced the concept of using modern technology in wound diagnostics and spoke about the role of protease in wound healing and tissue repair.
Prof. Finn Gottrup provided the keynote address for day two. Prof Gottrup discussed the challenges in evidence and outcomes in wound healing and the challenges faced in designing randomised controlled trials in patients with chronic wounds. This session provided the platform for some interesting audience participation in the debate on wound healing outcomes and reinforced the need for further dialogue on this topic.
Economics would seem to be to the forefront of all our conversations related to resources at this time. Prof. Charles Normand provided some means through which one can consider economics and wound care and provided some valuable tools and resources which clinicians can use in making the case for additional resources. Ms. Susan Mendez-Eastman gave a comprehensive overview of the effect of topical negative therapy on wound tissues and healing outcomes. Dr. Caroline Dowsett explored the evidence in support of topical negative therapy currently and in the future of wound healing.
In a very interesting session, Ms. Dympna Pearson gave delegates a thought provoking presentation on health behavioural change with particular reference to nutrition and wound healing.
The final presentation of the conference by Dr. Marlese Dempsey was to remind is all of how fortunate we are to live in a country where we have access to health care and modern therapies. Dr. Dempsey recounted her role and that of her colleagues in the aftermath of the Haiti disaster in 2011.
During the conference four free papers were presented:
- Mr. Wael Tawfick and Mr. Sherif Sultan; Technical and Clinical Outcomes of Topical Wound Oxygen in comparison to conventional compression dressing in the management of refractory non-healing venous ulcers.
- Derk F. Frye and Liam Farrell; The use of human fibroblast derived dermal substitute with topical oxygen in vascular compromised wounds
- Paul Breen, Dr. C. McIntosh, Prof. J. Serrador, C. O’Tuathail, Dr. S. Dinneen, Prof. G. Ó Laighin: Sensory neuromodulation; a new paradigm to restore peripheral sensitivity
- Bryony Treston, Dr. G. Gethin, Prof. S. Tierney, M. Prendergast, H. Strapp, and Prof. S. Cowman: Prevalence of lower limb lymphoedema and quality of life among persons with diabetic foot disease
The association is most grateful to the massive industry support for this conference. Twenty seven companies met with delegates over the two days and the Journal of Wound Care supported the organisation through the development of a conference book.
We would like to thank the work and commitment of the conference organising committee and the national executive of the association. The next conference will be held in Cork in 2013 and we look forward to building on the work of 2011 and a bigger and better conference. We would also like to thank the many speakers who gave of their time to present but also the many hours which went into developing their presentations. Finally, we want to thank the many delegates who attended and hope that this conference goes in some way towards Building the Future of Wound Care.
- Georgina Gethin,
- Adelene Greene,
- Caroline McIntosh,
- Kate Arkley,
- Marie Mellett,
- Marion Cahill Collins
Two prize winners were announced:
Lilian Bradley memorial prize:
Madden, J. & Cundell, J. Can podiatrists identify the level of heel pressure damage as defined by the EPUAP classification, to ensure inter-rater reliability in assessing heel pressure damage?
Hamada, N., Soylu, E., Fahy, A., Tawfick, W. and Sultan , S. The results of the sequential compression biomechanical device in patients with critical limb ischemia and non-reconstructable peripheral vascular disease.
Moore Z, Cowman S (2012).Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. Journal of Clinical Nursing 21(3-4):362-71.
Aims and objectives
The aim of this study was to establish pressure ulcer prevalence and prevention in the long-term care setting.
There is no information on pressure ulcers prevalence in care of the older person in Ireland; therefore, a prevalence study was undertaken to investigate key aspects related to current practices in pressure ulcer prevention.
A cross-sectional survey design was employed.
Ethical approval was received. Participants included 1100 older individuals residing in 12 long-term care settings. Data were collected using the Braden scale, the European Pressure Ulcer Advisory Panel minimum data set and pressure ulcer grading system.
All participants were Irish and white, 70% were women, and 75% were aged 80 years or older. Prevalence was 9%, with 28% of pressure ulcers grade 1, 33% grade 2, 15% grade 3 and 24% grade 4, mainly located on the sacrum (58%) and the heel (25%). Seventy-seven per cent scored Braden low risk or not at risk; however, 53% were completely immobile/very limited mobility and 58% were chair/bedfast. There was a significant association between activity and mobility and pressure ulcer development (v2 = 45Æ50, p < 0Æ001 and v2 = 46Æ91, p = 0Æ0001, respectively). Fifty per cent had a pressure redistribution device in bed, and 48% had one in use on the chair; however, 9% had a repositioning regime planned for when in bed and 5% planned for when seated in the chair.
This paper reports on the first ever pressure ulcer prevalence survey conducted in long-term care in Ireland, and results provide significant insights into decision-making and use of resources in the prevention of pressure ulcers.
Relevance to clinical practice. Pressure ulcers are common, costly and impact negatively on individuals. Current practices in prevention show several areas for improvement, namely, risk assessment, care planning and documentation.
Lilian Bradley memorial Winning Poster
Jennifer Madden and Jill Cundell