Wound-related pain in people with chronic lower limb wounds is often underestimated and undertreated by clinicians^1,2 (Briggs, Bennett, Closs, & Cocks, 2007; Coutts, Woo, & Bourque, 2008). This paper provides an overview of the findings from a mixed methods study exploring the perceptions and experiences of healthcare practitioners (HCP) on the assessment and management of wound-related pain, in an effort to provide insights into the above deficit.

Aim The aim of this study was to explore whether assessments of wound pain are undertaken and what the barriers are to wound pain management, from the perspectives of HCP.

Method This study encompassed two research activities (an HCP survey and focus groups). An explanatory, sequential mixed method design combining data from the survey and the focus groups was used for the study.

Results At present, there is no consistent method for the assessment and management of wound-related pain. The key barriers to effective management of pain identified here are pain language, the attitudes and beliefs of HCP in relation to pain assessment and a lack of knowledge and skills in evidence-based practice in wound-related pain.

Conclusion There is a need for a universal clinical multidimensional wound pain assessment tool that incorporates clinical guidelines and prescriptive pathways for managing wound-related pain.

Background Venous ulcers of the lower limbs affect 1 to 3% of the Western population; at present, elastic compression is the first line of therapy. Some authors have found that insufficient deep venous circulation may delay ulcer healing during compression therapy.

Hypothesis/aim In a group of patients with venous ulcers, we verified whether or not deep venous insufficiency (DVI) associated with superficial venous insufficiency (SVI) may worsen the outcomes of four-layer elastic compression bandage (4LB).

Methods A total of 124 patients participated in the study. Ecocolordopper results of superficial and deep venous circulation examinations and the patient’s data, including age, sex and clinical history, were collected in an Excel database. A 4LB was applied, and patients were checked twice per week at our clinic, where therapeutic outcomes were recorded.

Results/Findings In 62 patients, we found only SVI (66.9%), DVI in 42 patients (33.9%, 38 popliteal veins, 17 femoral veins) and both SVI and DVI conditions in 26 patients (20.9%). In patients with SVI alone, the mean healing time was 81 ± 91 days, and in patients with DVI associated with SVI, it was 108 ± 123 days; the difference between the two groups was not statistically significant (p> 0.2). Ulcer healing was achieved in 90 patients— 41 with SVI alone, 21 with SVI combined with DVI; the difference was not statistically significant.

Conclusions Using 4LB allows ulcer healing with no difference in outcome between patients with SVI alone and those with SVI associated with DVI.

Implication for clinical practice A 4LB is effective in varicose ulcer therapy; the caregivers’ skills are critical, and home assistance for elderly patients is needed because too many live far from the hospital and cannot follow the therapy protocols on their own.

Abbreviations
DVI –Deep venous insufficiency
SVI – Superficial vein insufficiency
4LB –Four-layer bandage

Aim To describe needs and expectations from healthcare professionals while setting up a multidisciplinary wound clinic.

Methods An online survey was conducted in a 190-bed hospital in Western Switzerland from the 2nd to 15th of June 2020. Descriptive statistics were used to analyse the data.

Results A total of 166 healthcare professionals (118 nurses, 48 physicians) participated in the survey. Half of the participants (48%) saw the importance of setting up a wound clinic as 47% were taking care of wounds daily. Almost all participants (83 %) disclosed having no educational wound care background and half of them (54%) indicated having no skills and knowledge in wound management. The main aetiologies treated in a specialist centre should be diabetic foot, leg and pressure ulcers, then malignant wounds. It is expected a specialist clinic cares for complex or non-healing wounds. Furthermore, 48% of participants wished a multidisciplinary expert approach with a common protocol to guarantee a continuity of care. The wound centre should also have an educational role, essential in maintaining up-to-date practice.

Conclusions and implications for clinical practice In conclusion, a wound clinic should have a multidisciplinary specialist approach while ensuring evidence-based and uniform practices to provide a person-centred care. Furthermore, further-education must be offered.

Background Disfigurement and dysfunction of the face are attributes of body image disturbance in individuals with head and neck cancer. Research in body image has highlighted that people with head and neck cancer experience significant disfigurement and dysfunction with altered body image disturbance.

Although research has advanced our understanding and knowledge of the characteristics of body image and body image disturbance, there is a lack of focus on the theoretical frameworks that interrogate the body image construct in individuals with head and neck cancer and the role of the face in formulating this construct.

Aim This paper aims to appraise body image conceptual frameworks with an emphasis on the face as an integral organ in formulating body image.

Methods Schilder’s seminal body image conceptual framework was appraised and contrasted with that of Kolb’s and Price’s model as well as with the current evidence on body image disturbance in relation to the face.

Findings Body image conceptual frameworks are valuable tools for understanding body image and body image disturbances in individuals with head and neck cancer. However, Schilder’s framework integrates the physiological, psychological and sociocultural aspects the body image.

Conclusion Schilder’s framework embodies body image and enables an integrated and inclusive approach to body image in individuals with head and neck cancer.

Background Chronic wounds can have a substantial impact on quality of life, and their treatment and care can be costly. After witnessing the healing of a 4-year wound with the addition of goat’s milk consumption, it was decided to investigate further.

Aim To investigate whether the daily oral consumption of goat products is beneficial for promoting pressure injury healing among residents of long-term care (LTC) facilities.

Methods The subjects were permanent residents of an LTC facility with significant, long-lasting wounds, defined as any pressure injury at Stage 2 or more and existing for four or more months. Subjects were monitored for a six-month period. A total of 250 ml of goat dairy products were provided daily to each subject. Consumption was recorded daily. Wounds were monitored biweekly for size, stage, colour and change in condition. Participants were excluded if unable to complete the study or if less than 50% of the goat products were consumed over any month.

Results A total of 25 participants enrolled in the study; 17 completed the study, and 8 were excluded. A total of 24 pressure injuries were monitored from the 17 participants. Seventeen of the wounds closed during the six-month monitoring period.

Conclusions The results of the study indicate that consuming goat products may potentially promote pressure injury healing. Further study is needed.

Implications for clinical practice The results indicate that goat product consumption is feasible in an elderly population living in LTC, and it may have a positive effect on pressure injury healing. The treatment is minimally invasive and cost-effective.

Background Surgical site complications (SSCs) pose a major postoperative challenge. Single-use negative pressure wound therapy (sNPWT) systems have been shown to be effective for reducing SSCs. An upgraded sNPWT system (PICOTM 7) with improved functional performance and ease-of-use was assessed in a prospective, single-arm study. The study aimed to assess if the system was a safe and effective therapy for delivering consistent negative pressure.

Methods Between November 2018 and May 2019, eligible patients across 11 sites with a closed abdominal or knee arthroplasty incision, skin graft or flap, were enrolled. Postoperatively, patients received sNPWT for up to 7 days with follow-up until 30 days. Endpoints included the ability to maintain a consistent negative pressure for the intended duration, complication rates, clinician and patient usability and satisfaction and serious adverse events.

Results The device was capable of delivering consistent negative pressure across all assessed surgical wounds and was statistically equivalent to the reference negative pressure (-80.2 mmHg) (n=46; p=0.002). Low complication rates were observed within 30 days post-surgery. High levels of clinician usability (>90%) and patient satisfaction (95%) were reported. No serious device-related adverse events were reported.

Conclusions The study demonstrated the functional performance, favourable safety profile and clinician- and patient-reported satisfaction of this upgraded PICO 7 sNPWT device across multiple closed surgical wound types.

Implications Application of an sNPWT system can lead to improved wound healing outcomes within closed surgical wounds while also demonstrating high levels of clinician and patient satisfaction.

Pressure injuries (PIs) are important health problems all over the world because of their serious effects. Awareness of PIs and their effects has increased in recent years. Since patients’ relatives are part of the care team, they have an important role to play in the prevention of PIs. The most crucial aspect of the prevention of PIs is the education of healthcare professionals, patients and patients’ relatives and caregivers. This study aimed to educate caregivers on the prevention of PIs through the development of a digital game. With this purpose, we developed and used a technological education approach —a digital game— that employs gamification methods.