Placing the patient at the centre of chronic wound care: A qualitative evidence synthesis.

BACKGROUND: Chronic wounds are a major health burden and have a severe impact on well-being. This synthesis of qualitative studies was undertaken to inform a health technology assessment of antimicrobial wound dressings. It aimed to explore patients' experiences of chronic wounds and determine improvements for clinical practice. METHOD: Inclusion criteria included use of qualitative methods, and English language publication. Databases searched included MEDLINE (Ovid), MEDLINE in Process (Ovid), EMBASE (Ovid), CINAHL (EBSCOHost), and PsychInfo (EBSCOHost). Searches were limited to 1990-2014. The method of analysis was Framework synthesis. RESULTS: A total of 20 studies were included. The synthesis confirmed the severe physical, social and psychological impact of the chronic wound. Inadequately controlled pain and sleeplessness, restrictions to lifestyle, and the loss of previous life roles can lead to feelings of hopelessness and helplessness and therefore depression and anxiety. Dressings and dressing changes are a key aspect of treatment and provide opportunities for positive interaction and person centred-care. CONCLUSION: People with chronic wounds can be supported to live well within the severe physical, psychological and social restrictions of a chronic wound. Effective clinical pain management and the recognition of the experience of acute and chronic pain are of the utmost importance to people with a chronic wound. Treatment should not be purely focused on healing but incorporate symptom management, coping and wellbeing via person-centred and holistic care.

Patient views on antimicrobial dressings in chronic wounds.

BACKGROUND: Antimicrobial wound dressings (AWDs) may not consistently be used effectively. The authors aimed to explore what patients want from AWDs and their experiences of them. METHODS: Healthcare Improvement Scotland undertook a health technology assessment (HTA) on the use of AWDs in chronic wounds. A focus group (n=8) and six telephone interviews were carried out. The data were analysed thematically. RESULTS: The participants were generally positive about AWDs. Some felt that access to AWDS was unjustifiably restricted because of costs. Participants reported wanting to try anything to heal their wound, or to control the symptoms. There was no one preferred AWD; what worked well for one person did not necessarily work for others. Patients experienced inconsistent access to AWDs, leading to frustration. CONCLUSION: Clinicians lack clear guidelines on the use of AWDs, which is resulting in inconsistency and increased burden for patients. Recommendations for the use of AWDs are given in the HTA, which is available on Healthcare Improvement Scotland's website.

Alcohol problems in a remand Scottish prisoner population.

PURPOSE: Alcohol misuse is internationally recognised as a major public health problem. The link between alcohol and crime is strong and offenders have a higher prevalence of alcohol problems when compared with the general population. Alcohol-related crime is estimated to cost the Scottish economy over £700 m per annum. The purpose of this paper is to measure the nature and prevalence of Alcohol Use Disorders (AUDs) in adult male prisoners on remand in a prison in Scotland. DESIGN/METHODOLOGY/APPROACH: Using the Alcohol Use Disorders Identification Test (AUDIT) screening tool, all new remand prisoners were screened over a two week period. FINDINGS: Prevalence of alcohol problems within the sample was high: 73 per cent of the sample was identified with an AUD, with 43 per cent with scores indicating possible alcohol dependence. ORIGINALITY/VALUE: This is the first study to focus solely on a remand prisoner population and the results show high levels of need. The criminal justice setting is ideally placed to identify and treat alcohol problems in this hard to reach population.