Key performance indicators to inform evaluation of wound care programmes for people with complex wounds: a protocol for systematic review.

OBJECTIVE: The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken. METHOD: Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer. RESULTS: Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search. CONCLUSION: This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

Insights into the neuroprotective effects of Salvia officinalis L. and Salvia microphylla Kunth in the memory impairment rat model.

Salvia species have a longstanding traditional culinary use, mostly being consumed in the Mediterranean diet as a common herb added to food. Salvia is commonly consumed as a herbal tea for memory enhancement. Alzheimer's disease (AD) is the most prevalent form of dementia affecting people worldwide Therefore, the current research aimed to investigate potential therapeutic benefits of Salvia officinalis (SOL) cultivated in Jordan and Salvia microphylla (SML) cultivated in Egypt with regard to acetylcholinesterase activity, ß-amyloid deposition and oxidative stress associated with scopolamine-induced AD. Metabolite profiling of the ethanol extracts of SOL and SML was performed using UPLC-ESI-MS/MS analysis. Methyl carnosate, carnosic acid, carnosol, rosmanol and salvianolic acids were the major secondary metabolites identified in SOL and SML extracts. In our study, scopolamine (1.14 mg kg-1, i.p.) was administered for 7 consecutive days to induce memory impairment in rats. SML and SOL (150 and 300 mg kg-1, p.o.) were tested for their effects to reduce the scopolamine-induced deficits. Donepezil (0.5 mg kg-1, i.p.) was used as a positive control. Scopolamine induced histopathological changes in rats' prefrontal cortex and hippocampus in addition to ß-amyloid plaque deposition. Furthermore, scopolamine treatment promoted oxidative stress and acetylcholinesterase activity. On the other hand, treatment with Salvia extracts corrected the histological changes induced by scopolamine and significantly reduced ß-amyloid deposition. Moreover, both oxidative stress markers and acetylcholinesterase activity were ameliorated by Salvia treatment. Using virtual docking to the active sites of the human acetylcholinesterase crystal structure, salvianolic acid K, rosmarinic acid and salvianolic acid C showed the best fitting binding modes to active sites of acetylcholinesterase. Accordingly, the present study demonstrates the beneficial effects of Salvia species from Egypt and Jordan against scopolamine-induced AD-like disorder.

Professionals' Knowledge, Attitudes, and Practices Related to Pressure Injuries in Canada.

BACKGROUND: Pressure injuries (PIs) represent a significant burden on the healthcare system and have a negative impact on the quality of life of those affected by these wounds. Despite best practice guidelines and other protocols to help healthcare facilities prevent PIs, the prevalence of PIs in Canada across all healthcare settings is concerning. OBJECTIVE: To describe the pattern of PI prevention and identify national priorities and opportunities to address PIs. METHODS: A descriptive, cross-sectional, online survey was created between August and December 2017 to explore Canadian healthcare professionals' knowledge, attitudes, and practices related to PIs. RESULTS: In total, 590 surveys were completed. Eighty-five percent of respondents confirmed that PIs occur in their work environments, and 29% claimed PIs are a frequent occurrence. Most of the respondents (91%) confirmed that they were part of a team that treats PIs. Of the 590 participants, 90% confirmed that they are aware of PI prevention devices and technologies. Between 80% and 90% attest to using offloading devices including prophylactic dressings to prevent PIs, but only 20% instituted measures to address moisture-associated skin damage. CONCLUSIONS: The findings from this survey have highlighted a disconnect between Canadian healthcare professionals' awareness of PIs and the implementation of best practices for PI prevention. It is evident that, although the majority of respondents were aware of PIs and related treatment protocols, barriers still exist that impede optimized care and treatment.

Toenail Onychomycosis-A Canadian Approach With a New Transungual Treatment: Development of a Clinical Pathway.

BACKGROUND: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. OBJECTIVE: To define a patient-centred Canadian treatment strategy for onychomycosis. METHODS: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. RESULTS: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. CONCLUSION: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.

Diabetic foot ulcers: Part I. Pathophysiology and prevention.

Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.

Diabetic foot ulcers: Part II. Management.

The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality.

Best practices for the management of foot ulcers in people with diabetes.

Care of people with diabetic foot ulcers requires a systematic approach following the wound bed preparation paradigm and the existing best practice recommendations. The purpose of this article is to summarize key evidence and recommendations regarding prevention and management of diabetic foot ulcers that can be translated into practice.

Evaluation of a peer-led self-management education programme PEP Talk: Diabetes, Healthy Feet and You.

PEP (Peer Education Programme) Talk: Diabetes, Healthy Feet and You is a peer-led self-management programme developed to address the problems of growing prevalence of diabetes and its complications, and limited health care dollars. An evaluation of the programme, how it might be situated within a public health perspective and potential bridges for its implementation in communities throughout Canada and worldwide, are presented. The programme consisted of workshops that were conducted by volunteer peer leaders and health care professionals in 12 communities in 10 Canadian provinces; the volunteers were supported through monthly mentoring teleconferences, on-line tips and discussion board conversations. A web portal was developed to be used by the team, volunteers and community participants. Workshop curriculum was developed based on diabetes footcare and self-management best practise guidelines. Community participants answered pre-and post-workshop statements that indicated that learning occurred, as indicated by an increase in the number of statements answered correctly. Participants' feedback about the workshops was positive. In telephone follow-up interviews, 97% of respondents reported having changed their foot self-management behaviours. The portal was commonly used according to website visits, but not as much as expected for registration of community participants. It is recommended that this programme be made widely available and tailored to the specific needs of the communities and that further evaluation be conducted.

Screening for the high-risk diabetic foot: a 60-second tool (2012).

People with diabetes mellitus will develop lower-limb complications, such as neuropathy, peripheral vascular disease, foot ulcers, and lower-leg amputations. Resources to control elevated hemoglobin A1c and blood pressure, along with the standardized approach using the 60-second tool (2012), can detect the high-risk diabetic foot and help prevent complications.

Role of a point-of-care protease activity diagnostic test in Canadian clinical practice: a Canadian expert consensus ©.

Nonhealing wounds (stalled, healable) challenge affected individuals, wound clinicians, and society. Nonhealing may result despite local factors being corrected. The interplay between tissue degradation, increased inflammatory response, and abundant protease activity is a challenging quandary. A modified Delphi process was utilized to investigate a protease activity test and practice implications.