RESUMO
Demographic and epidemiological data suggest that health-care demand will increase considerably in the future as a result of an ageing population and a rise in the prevalence of chronic diseases such as diabetes. This phenomenon has come to be referred to as the 'health care time bomb' in the popular press and political discourse. The authors seek to look beyond the headlines and political rhetoric to clarify the extent to which they reflect the likely future reality with a specific focus on wound management. The present-day burden that wounds and current wound management practices place upon the health-care system are detailed and clarified, and the potential future implications of increasing wound prevalence on the current picture are explored. Possible opportunities to enhance current wound management practice as identified in the analysis are discussed.
Assuntos
Bandagens , Serviços de Saúde Comunitária/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Úlcera da Perna/terapia , Úlcera por Pressão/terapia , Alocação de Recursos/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Lactente , Recém-Nascido , Úlcera da Perna/economia , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/economia , Fatores Socioeconômicos , Reino Unido , Cicatrização , Adulto JovemRESUMO
AIM: Negative Pressure Wound Therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer-reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this communication the results of the study of evidence in chronic wounds including pressure ulcers, diabetic foot ulcers (DFU), venous leg ulcers (VLU), and ischaemic lower limb wounds are reported. METHODS: Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% agreement. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. RESULTS: The primary treatment goal of NPWT in most chronic wounds is to achieve wound closure (either by secondary intention or preparing the wound for surgical closure). Secondary goals commonly include: to reduce wound dimensions, and to improve the quality of the wound bed. Thirteen evidence based recommendations were developed in total to address these treatment goals; 4 for pressure ulcers, 4 for DFU, 3 for ischaemic lower limb wounds and 2 for VLU. CONCLUSION: The present evidence base is strongest for the use of NPWT in non-ischaemic DFU and weakest in VLU. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
Assuntos
Prática Clínica Baseada em Evidências/normas , Tratamento de Ferimentos com Pressão Negativa/normas , Úlcera Cutânea/fisiopatologia , Úlcera Cutânea/terapia , Cicatrização , Doença Crônica , Consenso , Humanos , Cooperação Internacional , Guias de Prática Clínica como AssuntoRESUMO
Negative pressure wound therapy (NPWT) is becoming a commonplace treatment in many clinical settings. New devices and dressings are being introduced. Despite widespread adoption, there remains uncertainty regarding several aspects of NPWT use. To respond to these gaps, a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In a previous communication, we have reviewed the evidence base for the use of NPWT within trauma and reconstructive surgery. In this communication, we present results of the assessment of evidence relating to the different NPWT treatment variables: different wound fillers (principally foam and gauze); when to use a wound contact layer; different pressure settings; and the impact of NPWT on bacterial bioburden. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence and drafting of the recommendations by a global expert panel. Evidence and recommendations were graded according to the Scottish Intercollegiate Guidelines Network (SIGN) classification system. In general, there is relatively weak evidence on which to base recommendations for any one NPWT treatment variable over another. Overall, 14 recommendations were developed: five for the choice of wound filler and wound contact layer, four for choice of pressure setting and five for use of NPWT in infected wounds. With respect to bioburden, evidence suggests that reduction of bacteria in wounds is not a major mode of action of NPWT.
Assuntos
Tratamento de Ferimentos com Pressão Negativa/métodos , Ferimentos e Lesões/terapia , Antibacterianos/administração & dosagem , Bandagens , Redução de Custos , Drenagem/instrumentação , Drenagem/métodos , Medicina Baseada em Evidências , Humanos , Isquemia/complicações , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Dor/prevenção & controle , Poliuretanos , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Cicatrização , Ferimentos e Lesões/economiaRESUMO
Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
Assuntos
Tratamento de Ferimentos com Pressão Negativa/métodos , Procedimentos de Cirurgia Plástica , Guias de Prática Clínica como Assunto , Ferimentos e Lesões/terapia , Queimaduras/terapia , Síndromes Compartimentais/cirurgia , Consenso , Desbridamento , Medicina Baseada em Evidências , Sobrevivência de Enxerto , Humanos , Necrose , Transplante de Pele/métodos , Retalhos Cirúrgicos , Técnicas de Fechamento de Ferimentos , Cicatrização/fisiologia , Ferimentos e Lesões/patologiaRESUMO
This article, the first in a series of three, explores exudate management using a patient-centred approach. It outlines the challenges in achieving an optimum moisture balance and the implications for the patient when this does not occur.
Assuntos
Bandagens , Exsudatos e Transudatos , Avaliação em Enfermagem/métodos , Assistência Centrada no Paciente/métodos , Higiene da Pele/métodos , Ferimentos e Lesões/prevenção & controle , Doença Aguda , Bandagens/efeitos adversos , Bandagens/provisão & distribuição , Doença Crônica , Humanos , Planejamento de Assistência ao Paciente/organização & administração , Participação do Paciente/métodos , Participação do Paciente/psicologia , Seleção de Pacientes , Fatores de Risco , Higiene da Pele/enfermagem , Higiene da Pele/psicologiaRESUMO
This paper explores the nature of evidence and how it has evolved in recent years, and sets out a process for assembling and assessing the evidence to support wound bed preparation as an effective method of managing chronic wounds
Assuntos
Medicina Baseada em Evidências , Higiene da Pele/métodos , Ferimentos e Lesões/terapia , Anti-Infecciosos Locais/uso terapêutico , Bandagens , Protocolos Clínicos , Desbridamento/métodos , Técnicas de Apoio para a Decisão , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Modelos de Enfermagem , Avaliação em Enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Higiene da Pele/enfermagem , Resultado do Tratamento , CicatrizaçãoRESUMO
The final article in a six-part series on leg ulcers focuses on developing leg ulcer services in the community and stresses the importance of taking a holistic approach and the value of patient/carer education to promote concordance.
Assuntos
Comportamento de Escolha , Reforma dos Serviços de Saúde/organização & administração , Úlcera da Perna , Participação do Paciente/psicologia , Medicina Estatal/organização & administração , Centros Comunitários de Saúde , Enfermagem em Saúde Comunitária , Promoção da Saúde , Humanos , Úlcera da Perna/enfermagem , Úlcera da Perna/psicologia , Modelos de Enfermagem , Avaliação das Necessidades , Avaliação em Enfermagem , Auditoria de Enfermagem , Educação de Pacientes como Assunto , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Higiene da Pele/psicologia , Reino Unido , CicatrizaçãoRESUMO
This is the first of six articles on how to tackle the challenges faced when caring for patients with leg ulcers, with the aim of improving services and patient outcomes. This paper overviews diagnosis, treatment options and delivery of care.
Assuntos
Qualidade da Assistência à Saúde , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/terapia , Bandagens , Benchmarking , Humanos , Avaliação em Enfermagem/métodos , Guias de Prática Clínica como Assunto , Ultrassonografia Doppler , Reino Unido , Úlcera Varicosa/enfermagemRESUMO
The government has introduced a framework for clinical governance as a means to promote high quality services for patients. Caroline Dowsett discusses the importance of adopting a positive approach to clinical governance within pressure ulcer management.
Assuntos
Auditoria Médica/organização & administração , Úlcera por Pressão/prevenção & controle , Gestão da Qualidade Total/organização & administração , Bandagens/normas , Tomada de Decisões Gerenciais , Humanos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Úlcera por Pressão/etiologia , Medição de Risco , Fatores de Risco , Higiene da Pele/métodos , Higiene da Pele/enfermagem , Higiene da Pele/normas , Medicina Estatal/normas , Reino UnidoRESUMO
Many community nurses work in relative isolation and may lack training in leg ulcer management. The winner of the Wound Care Nurse of the Year in the Professional Nurse Awards 1997 set up a scheme to improve nursing knowledge and patient care.