Interface pressure: what does it mean in clinical practice?

ABSTRACT: Pressure ulcers generally occur at body sites where there are sustained soft tissue stress concentrations associated with either bodyweight or medical devicerelated mechanical forces. These sustained mechanical forces caused by pressure and shear result in localised tissue/cell distortion. This leads to deformation-induced damage, inflammation and ischemia resulting in tissue death and, ultimately, a pressure ulcer (Katz and Gefen, 2023).

      In order to reduce the risk of pressure damage occurring, it is common in clinical practice to select a pressure redistributing support surface (mattress or cushion). It is also important to reposition the patient in order to both change the areas that are load bearing and — as much as possible — increase the surface area of the body that is supporting the load, while avoiding positioning on the most at-risk areas, for example the bony prominences.

KEY WORDS

Interface pressure

Pressure mapping

Pressure ulcer

JACQUI FLETCHER

Independent Nurse Consultant

Implementing an evidence-based pathway to improve outcomes for non-healing wounds

ABSTRACT: In order to provide structured and equitable interventions in relation to identification and management of wound infection, an NHS Trust has implemented an evidence-based pathway for non-healing wounds. Following the introduction of the pathway there were reduced nurse visits for wound assessment, a reduction in wound area, a reduction in necrotic tissue and improved healing rates.

KEY WORDS

Case study

Evidence

Infection

Pathway

Silver dressing

UrgoClean Ag

Wound

ANITA KILROY-FINDLEY, Clinical Lead Tissue Viability, Leicestershire Partnership NHS Trust

KAREN OUSEY, PhD, Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield

Frugal innovation in wound management within a low resource inpatient setting: a case series

Objective: This article highlights challenges of wound care in low resource settings, considering opportunities for frugal innovation and our experiences while creating virtual wound care clinics across two global communities. In addition, we will discuss four real cases presented within the virtual clinics. An adaptation of the widely accepted tissues, infection, moisture, edge, regeneration and repair of tissue, and social factors (TIMERS) wound assessment is also proposed with considerations for low-resource setttings. 

Method: From March to December 2021 the University of Salford engaged in a virtual wound clinic initiative with colleagues in Fort Portal Regional Referral Hospital.

Results: The clinics provided opportunities for professional and academic development of students on postgraduate tissue viability module in Salford, while empowering nurses and midwives in Uganda in taking their place at the centre of multidisciplinary teams in care delivery Furthermore, it created links between the university and clinicians in Uganda to develop the delivery of evidence-based wound management. Throughout this period, challenges associated with low resources were highlighted and, in some cases, innovative approaches to managing wound care were adopted to account for this.

Conclusions: The development and delivery of the virtual wound care clinics between the University of Salford and Fort Portal Regional Referral Hospital provided an opportunity for reflection on practice. This led to development of a Fit4purpose wound dressing, revision of evidence-based guidelines, deeper understanding of the scarcity of essential items and frugal practice, and examination of skin tone bias in the signs and symptoms of wound infection in patients with dark skin tones.

KEY WORDS

Case series

Dressings

Frugal innovation

Low resource

Uganda

Wounds

DR MELANIE STEPHENS

PhD, RGN, Senior Lecturer in Adult Nursing and Lead for Interprofessional Education, School of Health and Society, Mary Seacole Building, University of Salford, UK

MATTHEW WYNN,

MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK

SHEBA PRADEEP

MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK

LOUISE ACKERS

Chair in Global Social Justice, Director Knowledge, Health and Place Research

RACHEL NAMIRRO

Registered Midwife, Assistant Nursing Officer, Knowledge for Change, Fort Portal, Kabarole District, Uganda

BECKY MASKEW,

BSc Nursing (Adult), Staff nurse, Fairfield General Hospital, Northern Care Alliance, UK

SARAH SULEIMAN

Student Nurse CYP, School of Health and Society, Mary Seacole Building, University of Salford, UK

JANE BOARDMAN, BA Hons, Student Nurse, School of Health and Society, Mary Seacole Building, University of Salford, UK

DEREK BAHANDAGIRA, Registered Nurse, Assistant Nursing Officer, Surgical, Paediatrics, and Diabetes Clinic, Fort Portal Regional Referral Hospital, Uganda

ANGELA MUGUMBA,

Certificate of Registration Midwife, Assistant Nursing Officer, Knowledge for Change, Labour/Gynaecology Ward, Fort Portal Regional Referral Hospital, Uganda

KAYLEIGH THORNTON,

MA, Registered Midwife, Stockport Foundation Trust, UK AUGUSTINE SSEMUJJU, MMed (Obstetrics & Gynaecology), Specialist in Obstetrics and Gynaecology, Fort Portal Regional Referral Hospital, Uganda

YASMIN CAPEL, MBBS, Doctor, Knowledge for Change, Fort Portal Regional Referral Hospital, Uganda ODUR JOE, BSc, Pharmacist, Fort Portal Regional Referral Hospital, Pharmacy Stores

NALUKENGE PROSCOVIA,

Senior Theatre Assistant, Fort Portal Regional Referral Hospital, Uganda

HANNAH RANK, MBChB,

Doctor, Knowledge for Change, Fort Portal, Kabarole District, Uganda

AGNIESZKA SZYMKOWIAK,

MSc, CYP Nurse, Guy's and St Thomas NHS Trust, UK

National Wound Care Strategy update: pressure ulcer consultation

JACQUI FLETCHER OBE

Senior Clinical Advisor Stop the Pressure Programme/National Wound Care Strategy NHS England Clinical Implementation Manager

Complex wound healing with topical negative pressure wound therapy: a case study

Surgical wound dehiscence (SWD), a complication of surgery, can delay wound healing, increase the economic burden of the healthcare provider, and have a negative impact on the patient’s wellbeing. The fundamental goal for the treatment of SWD is wound closure. This article describes the use of Avance® Solo, a negative pressure wound therapy system, selected as a therapy for both the prevention and treatment of dehisced closed surgical incision wounds in a patient with complex and social needs.

KEY WORDS

Negative pressure wound therapy (NPWT)

Patient wellbeing

Surgical wound dehiscence

Wound healing

LISA SUTHERLAND

MSC RN LLB(HONS), Nurse Consultant for Wound Management and Tissue Viability, Norfolk anad Norwich University Hospital; Honorary Lecturer, University of East Anglia, Norwich, UK

What are the effects of Covid-19 on diabetes and foot complications associated with diabetes?

N Rezai

The Covid-19 pandemic, with its disruption of services and higher mortality risk has had far-reaching consequences for people with diabetes, contributing toward increased risk of rapid deterioration, ICU admissions and a worse prognosis. Covid-19 also affected access to diabetes related foot care and multidisciplinary services, with long-term implications for people who were unable to access care and attend clinic appointments during the pandemic. This review examines studies on the effect of Covid-19 on people with diabetes, foot complications associated with diabetes and service delivery.

Citation: Rezai N (2023) What are the effects of Covid-19 on diabetes and diabetic foot-related complications?. The Diabetic Foot Journal 26(1): 40–5

Key words

- Covid-19

- Foot care access

- Service provision

- Telemedicine

Article points

1. People with diabetes are more likely to be more unwell with Covid-19.

2. Foot care services were severely disrupted during the pandemic.

3. Lessons learned from the pandemic give avenues to investigate for footcare services in future.

Author

Miss Nealoofar Rezai, BSc (Hons) MRCPod, is Clinical Lead Podiatrist, Royal Free Hospital, London, UK