Characteristics of COVID-19 patients who developed pressure injuries: a scoping review.

OBJECTIVE: To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD: A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS: In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION: PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.

The clinical and cost effectiveness of remote expert wound nurse consultation for healing of pressure injuries among residential aged care patients: A protocol for a prospective pilot parallel cluster randomised controlled trial.

Pressure injuries affect 1 to 46% of residents in aged care (long term) facilities and cause a substantial economic burden on health care systems. Remote expert wound nurse consultation has the potential to improve pressure injury outcomes; however, the clinical and cost effectiveness of this intervention for healing of pressure injuries in residential aged care require further investigation. We describe the remote expert wound nurse consultation intervention and the method of a prospective, pilot, cluster randomised controlled trial. The primary outcome is number of wounds healed. Secondary outcomes are wound healing rate, time to healing, wound infection, satisfaction, quality of life, cost of treatment and care, hospitalisations, and deaths. Intervention group participants receive the intervention over a 12-week period and all participants are monitored for 24 weeks. A wound imaging and measurement system is used to analyse pressure injury images. A feasibility and fidelity evaluation will be concurrently conducted. The results of the trial will inform the merit of and justification for a future definitive trial to evaluate the clinical and cost effectiveness of remote expert wound nurse consultation for the healing of pressure injuries in residential aged care.

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial.

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 1-Development, pilot and refinement of the checklist.

Patients who have chronic wounds such as leg ulcers should be active participants in their treatment and care. This participation may include self-treatment of the wound which involves the patient cleaning the wound, applying and removing wound dressings, and/or applying and removing compression therapy. The aim of the study was to develop a Checklist to assist nurses to appraise the conduct of wound treatment when undertaken by the patient. A three-phase mixed methods study was conducted. A systematic and evidence-based approach to developing and using structured observations for the study of health behaviour guided the process of developing, piloting and refining the Checklist. The resulting "Self-Treatment of Wounds for Venous Leg Ulcers Checklist" (STOW-V Checklist V1.0) can assist the nurse to evaluate the conduct of key self-treatment behaviours in the areas of equipment and workspace, hand hygiene, wound dressing removal, skin care, wound cleansing and debridement, wound assessment, wound dressing application, and compression therapy application. The growing recognition that patients can benefit when involved in care, the need to enact self-management because of COVID-19, and the ever present competition for healthcare funding and resources are compelling reasons for patients, care providers, and healthcare services to afford the self-management approach, and associated interventions such as self-treatment, greater consideration. It is recommended that the STOW-V Checklist is used with patients in a shared-care model, with nurses and other healthcare professionals providing supervision and oversight of self-treatment practices whenever this is feasible and acceptable to the patient.

The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 2-The reliability of the Checklist.

The "Self-Treatment of Wounds for Venous Leg Ulcers Checklist" (STOW-V Checklist V1.0) is an evidence-based, standardised tool designed to assist nurses to appraise the conduct of wound treatment when undertaken by patients who have venous leg ulcers. A prospective reliability study was conducted to determine the reliability of the STOW-V Checklist V1.0. Video-recordings of patients who self-treated their leg ulcer were obtained (n = 5) and nurses (n = 15) viewed each video-recording three times and concurrently completed the Checklist. Internal consistency, inter-rater reliability and intra-rater reliability were evaluated. Cronbach's alpha for items in the Checklist was 0.792, 0.791 and 0.783 for Occasions 1, 2 and 3, respectively, indicating good reliability. Inter-rater reliability was 0.938, 0.958 and 0.927 for Occasions 1, 2 and 3, respectively; these results were statistically significant and indicative of excellent reliability. Intra-rater reliability was 0.403 to 0.999; these results were statistically significant and meeting or exceed adequacy in the case of all except two raters. The study provides preliminary evidence that the Checklist is measuring the concepts that it intends to measure and that there is a high level of agreement among raters. It is recommended that the STOW-V Checklist V1.0 is utilised with patients in a shared-care model, with nurses and other healthcare professionals providing supervision and oversight of self-treatment practices whenever this is feasible and acceptable to the patient.

Organizational strategies to optimize women's safety during labor and birth: A scoping review.

BACKGROUND: Safety is a priority for organizations that provide maternity care, however, preventable harm and errors in maternity care remain. Maternity care is considered a high risk and high litigation area of health care. To mitigate risk and litigation, organizations have implemented strategies to optimize women's safety. Our objectives were to identify the strategies implemented by organizations to optimize women's safety during labor and birth, and to consider how the concept of safety is operationalized to measure and evaluate outcomes of these strategies. METHOD: This scoping review was conducted using the Joanna Briggs Institute Scoping Review Methodology. Published peer-reviewed literature indexed in CINAHL, Medline, and Embase, databases from 2010 to 2020, were reviewed for inclusion. Fifty studies were included. Data were extracted and thematically analyzed. RESULTS: Three categories of organizational strategies were identified to optimize women's safety during labor and birth: clinical governance, models of care, and staff education. Clinical governance programs (n = 30 studies), specifically implementing checklists and audits, models of care, such as midwifery led-care (n = 11 studies), and staff training programs (n = 9 studies), were predominately for the management of obstetric emergencies. Outcome measures included morbidity and mortality for woman and newborns. Three studies discussed women's perceptions of safety during labor and birth as an outcome measure. CONCLUSIONS: Organizations utilize a range of strategies to optimize women's safety during labor and birth. The main outcome measure used to evaluate strategies was focused on clinical outcomes for the mother and newborn.

Home-based rehabilitation in inoperable non-small cell lung cancer-the patient experience.

PURPOSE: Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program. METHODS: Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). Individual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes. RESULTS: Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years; male 52%; disease stage n (%) III = 9 (36), IV = 11 (44); radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support; motivation to be stronger and better prepared for future challenges; and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence. CONCLUSIONS: This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms.

The effect of self-treatment of wounds on quality of life: a qualitative study.

OBJECTIVE: Skin wounds, such as leg ulcers and pressure ulcers (PUs), can have a negative effect on quality of life (QoL). This effect has been confirmed among self-treaters of wounds, specifically. The aim of the study was to investigate the effect of self-treatment of wounds on the physical, emotional, lifestyle and financial domains of QoL. The findings of the study may be used to optimise the wellbeing of people who have wounds. METHOD: A qualitative study was conducted with people who were 18 years of age or older; lived in Victoria, Australia; spoke English; and had a wound that they had self-treated. Participants were interviewed and the data thematically analysed to identify themes that represented the effect of self-treatment on the physical, emotional, lifestyle and financial domains of QoL. RESULTS: The participants (n=25) averaged 71 years of age and the majority (n=20) had leg wounds. Participants described mostly positive effects on QoL that were attributable to self-treatment. Self-treatment improved physical wellbeing because it resulted in better pain management and wound healing; however, it was a physical challenge for some. Self-treatment enhanced emotional wellbeing because it helped to manage worry about infection and resolve dissatisfaction with professional care. Self-treatment lessened the social consequences of the wound by enabling participants to create an acceptable appearance, maintain their lifestyle and minimise time receiving professional care. Self-treatment reduced the financial cost of wound dressings and the expense associated with receiving professional care. CONCLUSION: As an approach to care, self-treatment of wounds may offer QoL gains that might otherwise be unachievable. The importance of engaging patients in their own management, and the increasing accountability of healthcare providers to report consumer-focused outcomes, are further reasons to consider self-treatment of wounds as an approach to care in the community setting.

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose-designed positioning device and usual care equipment: An observational feasibility study.

The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side-lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose-designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose-designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high-risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z-Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side-lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°-26°, the foam wedge 29°-27°, and the pillow 23°-21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°-71°, a difference of 7°) and the pillow alone (79°-74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°-86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.

The direct cost of pressure injuries in an Australian residential aged care setting.

Pressure injuries have a negative effect on well-being and the cost of treatment places a significant burden on the health care system. Research has, however, tended to extrapolate or estimate the cost of pressure injuries resulting in uncertainty regarding the true cost of this condition. The aim of this prospective observational study was to quantify the cost of pressure injury treatment in the Australian residential aged care setting. An electronic health care record audit and observation of usual pressure injury treatment was undertaken with a sample of 20 participants who had 23 pressure injuries. The actual treatment cost, an evidence-based practice model cost, and a projected treatment cost were calculated. The overall cost of pressure injury treatment was AU$98,489.22. The average daily cost by pressure injury stage was AU$26.42 for a Stage 1 pressure injury, AU$37.17 for a Stage 2 pressure injury, AU$30.01 for a Stage 3 pressure injury, and AU$10.22 for an Unstageable pressure injury. The projected cost of treatment was AU$104,510.41. At 42 days this cost extended to AU$116,552.79. This study has quantified the cost of pressure injury treatment in a residential aged care setting. The study may inform future efforts to accurately calculate the cost of PIs and the effectiveness of strategies to reduce the economic burden of this condition.

An observational study of the maintenance of the 30°â€Šside-lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device.

The aim of the study was to evaluate the maintenance of the 30° side-lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated-measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.

The quality of life of people who have chronic wounds and who self-treat.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effect of chronic wounds on the physical, emotional, social, lifestyle and financial domains of quality of life among people who self-treat their wounds. BACKGROUND: Patient-centred models of care have received increased attention over recent decades because of the potential to contribute positively to the patient's health and well-being. A contemporary understanding of the effect of chronic wounds on quality of life may assist care providers and healthcare systems to respond to patient needs and improve patient outcomes. METHOD: A qualitative, exploratory study was conducted in Victoria, Australia. Participants were aged 18 years or older and had a chronic wound that was currently or previously self-treated. A sample of 25 participants was recruited from the community, and in-depth interviews were conducted in participants' homes. A thematic analysis was conducted to identify themes that represented the physical, emotional, social, lifestyle and financial domains of quality of life. RESULTS: Study participants (n = 25) were 71 years of age (average), and the majority had a leg wound. Participants experienced a negative effect on quality of life. Physical limitations affected activity and compromised the management of other health conditions. Participants felt frustrated with and distrusting of healthcare professionals from whom they received advice and care. Daily lifestyle and workforce participation were disrupted when receiving professional care. Wound treatment and professional care expenses negatively affected personal finances. CONCLUSION: Continued effort is required to develop relationships and treatment regimens that are conducive to healing and to optimise well-being. Additionally, healthcare systems should identify and address structural shortcomings of care services to create more patient-centred models of wound care in the community setting.

A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial.

Pressure injuries are prevalent in highly dependent aged care residents. This study investigated the clinical effectiveness of the application of the Mepilex Border Sacrum and Mepilex Heel dressings to prevent the development of facility-acquired pressure injuries. A total of 288 recently admitted residents were enrolled from 40 Australian nursing homes into a randomised controlled trial. Residents randomised to standard care (n = 150) received pressure injury prevention as recommended by international guidelines. Residents randomised to the intervention (n = 138) received standard pressure injury prevention care and had dressings applied to their sacrum and heels. Participants were comparable on demographic and physiological parameters. More residents in the control group developed pressure injuries than in the intervention group (16 vs 3, P = 0.004), and they developed more pressure injuries in total than residents in the intervention group. The results represent a relative risk reduction of 80% for residents treated with the dressings and for every 12 patients that we treated we prevented one pressure injury. Based on our findings, we conclude that the use of the Mölnlycke Mepilex Border Sacrum and Mepilex Heel dressings confers a significant additional protective benefit to nursing home residents with a high risk of developing a facility-acquired pressure injury.

Predicting delayed healing: The diagnostic accuracy of a venous leg ulcer risk assessment tool.

The aim of this study was to validate a newly developed tool that can predict the risk of failure to heal of a venous leg ulcer in 24 weeks. The risk assessment tool was validated, and performance of the tool was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Retrospective and prospective validation was conducted through multi-site, longitudinal studies. In the retrospective study (n = 318), 30% of ulcers did not heal within 24 weeks, with the tool demonstrating an AUC of 0.80 (95% CI, 0.68-0.93, P < .001) for the total score. In the prospective study across 10 clinical sites (n = 225), 31% (n = 68) of ulcers did not heal within 24 weeks. Participants were classified with the RAT at enrolment as being at low risk (27%), moderate risk (53%) or high risk (20%) of delayed healing; the proportion of wounds unhealed at 24 weeks was 6%, 29% and 59%, respectively. Validation results of the total score indicated good discrimination and goodness of fit with an AUC of 0.78 (95% CI, 0.71-0.85, P < .001). Validation of this risk assessment tool offers assurance that realistic outcomes can be predicted for patients, and scores can guide early decisions on interventions to address specific risk factors for failing to heal, thus promoting timely healing.

Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool.

The aim of this study was to validate a newly developed tool for predicting the risk of recurrence within 12 months of a venous leg ulcer healing. Performance of the tool to predict recurrence within a 12-month period was assessed using Area Under the Receiver Operating Characteristic Curve (AUC) analysis. Multi-site retrospective and prospective longitudinal studies were undertaken to validate a risk assessment tool for the recurrence of venous leg ulcers within 12 months. In the retrospective study (n = 250), 55% of venous leg ulcers recurred within 12 months, and the risk assessment total score had excellent discrimination and goodness of fit with an AUC of 0.83 (95% CI, 0.76-0.90, P < .001). The prospective study (n = 143) observed that 50.4% (n = 63) of venous leg ulcers recurred within 12 months of healing. Participants were classified using the risk assessment tool as being at low risk (28%), moderate risk (59%), and high risk (13%); the proportion of wounds recurring at 12 months was 15%, 61%, and 67% for each group, respectively. Validation results indicated good discrimination and goodness of fit, with an AUC of 0.73 (95% CI, 0.64-0.82, P < .001). Validation of this risk assessment tool for the recurrence of venous leg ulcers provides clinicians with a resource to identify high-risk patients and to guide decisions on adjunctive, tailored interventions to address the specific risk factors to decrease the risk of recurrence.

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

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. The objectives of this research were to describe the out-of-pocket wound treatment costs and the quality of life of people who have chronic wounds. A questionnaire incorporating the Cardiff Wound Impact Schedule and purpose-designed instruments was completed by a non-probability, convenience sample of 113 people in Australia and Wales. Data was analysed using descriptive statistics. The sample was on average 63·6 years of age and had wounds that were on an average 109 weeks duration. Participants had spent on average AU$2475 on wound dressing products since the wound started, and AU$121·82 in the most recent 28 days which represented 10% of their disposable income. Health-related quality of life was sub-optimal, 6/10 (ave) according to the Cardiff Wound Impact Schedule. Younger participants reported significantly poorer quality of life on all CWIS sub-scales when compared to older participants. This study found that chronic wounds present a significant financial cost to individuals who must self-fund their wound dressings and other wound treatment related expenses. Participants who had access to wound product subsidisation also experienced personal financial costs. People who have chronic wounds experience sub-optimal quality of life therefore this condition is also costly to the individual's well-being. The quality of life of younger people has not received adequate attention and requires further consideration given the many years that younger people may have to live with this debilitating and often recurrent condition. Continued action is required to reduce the financial and personal costs experienced by people who have chronic wounds. It is imperative that healthcare funding is directed to people who have chronic wounds, in particular to alleviate the out-of-pocket costs experienced by self-funders. Continued attention to the quality of life of people who have chronic wounds is required to minimise the negative effects of this condition and enhance well-being.

How and why patients self-treat chronic wounds.

The aim of this study was to investigate how people self-treat chronic wounds, why they self-treat and the assistance and support that they receive. The increasing emphasis on self-management of chronic conditions, the potential benefits of self-treatment to the health care consumer and competing demands on health care funding are good reasons to investigate self-treatment of chronic wounds as we have little data on this group of individuals. A survey study was conducted in Australia. A non-random sample of 100 participants was recruited. Participants were aged 18 years or older and currently or previously had a chronic wound that they self-treated. All participants completed one survey. Data analysis involved descriptive statistics. The sample was, on average, 64·6 years of age; half was female (n = 50, 50%), and the majority had a lower leg wound (n = 80, 80·0%). The sample scored 33·9/40 on the Generalized Self-efficacy Scale and 68/100 on the Medical Outcomes Social Support Scale. The majority of the 89 participants who used a wound dressing used a product that targeted bacteria (n = 59, 66.3%). The two most commonly selected reasons for self-treating were 'to be independent' (n = 58, 58·0%) and 'to do the treatment at a time that suited' (n = 55, 56·0%). Less than one quarter of participants reported being supervised regularly during the wound episode (n = 22, 22%), and few (n = 6, 6·0%) reported having received education and training to support their self-treatment. Self-treaters of chronic wounds may benefit from standardised education and closer professional supervision to optimise self-treatment practices. Efforts to improve patient satisfaction with professional care are required to promote a shared-care model when self-treating and to optimise patient outcomes.

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 $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.

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

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.