Aims To elucidate reasons for non-concordance with compression bandaging, subject the identified reasons to thematic analysis and use the resultant themes as the basis for the development of a screening tool to identify those patients at risk of non-concordance with compression bandaging.

Method A literature search was undertaken using the terms ‘concordance’, ‘compression bandaging’ and ‘venous leg ulcer’. Articles were included if they discussed reasons for non-concordance with compression bandaging. Forty-one articles were identified which met inclusion criteria. The full texts were read and the reasons for non-concordance tabulated. These were then subjected to thematic analysis.

Results Six themes emerged. These were termed knowledge deficit; resource deficit; psychosocial issues; pain/discomfort; physical limitations; and wound management. These themes were used to develop a screening tool to identify patients who exhibit barriers to concordance with compression bandaging.

Discussion Compression bandaging is the recommended treatment for venous leg ulceration^1-3. However, the degree of concordance with compression bandaging therapy remains at sub-optimal levels^4,5. Consequently patients experience protracted ulceration. The development of a risk screening tool for non-concordance will permit targeted intervention to address barriers to concordance before the patient has a poor experience of compression therapy.

Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention.

Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration.

Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia.

Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times).

Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke).

Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity.

Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001).

Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing.

Background Pain in chronic lower limb wounds has been identified as one of the most painful wounds and negatively impacts health-related quality of life and wound healing. In order to optimise pain management, it is necessary to accurately assess wound pain, however there is no identified reliable and valid assessment specifically for wound-related pain in the lower extremities. 

Objective The objective of this review was to identify how wound-related pain is assessed in people with chronic lower limb wounds. 

Design A scoping review of the literature was conducted. 

Methods A search of MEDLINE, EMBASE, CINAHL and PsycINFO was undertaken of eligible studies that reported on assessment tools for pain in chronic lower limb wounds from inception 1946 to current June 2018. Systematic reviews, meta-analyses, randomised controlled trials, observational and qualitative studies were included. 

Discussion This study investigated the current assessment tools being utilised for pain in chronic lower limb wounds. 

Conclusion There is no validated pain assessment tool for patients with chronic lower limb wounds.

Many rural areas of New South Wales, Australia, have limited access to community podiatry and no high-risk foot (HRF) clinics. Private practitioners in these areas develop their own multidisciplinary teams (MDT) involving local professionals of different disciplines to provide evidence-based care for their patients. This case study shows co-ordinated care in a rural setting for a disunited navicular fracture in a patient with diabetes T2, familial neuropathy, a history of osteomyelitis and previous minor foot amputations. It explores the difficulties of wound care when treating complex cases without access to immediate consultations across all the specialties and highlights the need for better access to MDT HRF clinics for those clients with complex care needs.

Iodine-based preparations have been used for almost two centuries in the prevention of surgical site and other wound infections, but they can be toxic to tissue. Cadexomer iodine is an iodophor, which provides controlled release of iodine without cytotoxic effects. Cadexomer iodine is a long-established topical antimicrobial, which is used in the treatment of a variety of wounds. Its therapeutic efficacy is supported by a large body of clinical evidence. Moreover, ongoing research continues to reveal new insights into the mode of action of cadexomer iodine, and suggests new therapeutic applications. In addition, new clinical evidence/reviews in the form of Cochrane Reviews reveals comparisons to a wide range of topically applied wound care therapies.