The ghost of Nora Batty: A qualitative exploration of the impact of footwear, bandaging and hosiery interventions in chronic wound care

Madden, Mary

doi:10.1177/1742395314566824

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Another means of avoiding risk or blame is to stick rigidly to guidelines, which are often based on poor evidence, without tailoring them to the person being treated [67]. From a patient perspective, the physical and social discomfort of wound care treatments can lead to ambivalence about their effectiveness [94].…”

Section: Risk Regulation and The Evidence Basementioning

confidence: 99%

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Madden

Stark

2019

Journal of Tissue Viability

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Contemporary wound care in the UK has developed into two distinct complex wound care management spheres. The acute wound characterised by the contemporary, aggressive management of major trauma, and chronic wound care where there is widespread use of the term 'advanced' although, arguably its methods remain largely traditional [1]. Chronic wound care in the UK has now few connections with the more specialised systems that have developed for less prevalent burns and also for dermatological conditions [2,3]. Most management of people with complex wounds in the UK occurs in the community rather than in hospital with referral to a disparate range of health professionals including tissue viability nurses, vascular surgeons, podiatrists, physiotherapists, dermatologists, and occupational therapists. The bulk of the work is subsumed in community nursing.The historical literature on wound care has tended to concentrate on hospital-based, acute clinical activity, even though wound care decision-making, prevention and treatment are often the preserve of nursing and of patients themselves in the domestic rather than, or in addition to, the clinical sphere. While there has been much research examining the historical context of acute surgical wounds and injuries sustained on the battlefield [4], or 'wounding' as a predominantly socio-cultural process before the modern period [5], the case of chronic wounds has yet to be investigated.In 1962 George Winter published his observation that wounds in young pigs healed more quickly if covered rather than being left open to the air [6]. This has been widely seen as the starting point for 'advanced wound care' because it established the idea that a wound dressing could influence outcomes. It was followed by the introduction of occlusive and semi-occlusive dressings and various branded products such as Opsite from the 1980s. Wound care is now a multi-billion pound industry, yet there is a lack of recognition that products themselves are only a part of the story. As in other areas of healthcare, such as minimally-invasive surgery [7] and joint replacement [8], the development of innovation in this field can be seen as a multifaceted, uneven and contested process, not the simple invention and introduction of 'advanced' products and services.Drawing on historical, sociological and health sciences research and recordings of a series of Arts and Humanities Research Council (AHRC) funded cross disciplinary workshops connecting academics from a wide range of disciplines with service users, professionals and carers [9], this paper explores advanced wound care in the UK as a specific exemplar with wider resonance for understanding the particular climates in which clinical judgement and innovation adoption take place. It argues that with the historical shift from dry to moist wound healing came a narrow product focus in wound care which is intimately connected with the history of the professional development of AbstractGeorge Winter's 1962 paper in Nature reported his observation that wounds in ...

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Section: Risk Regulation and The Evidence Basementioning

confidence: 99%

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Madden

Stark

2019

Journal of Tissue Viability

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“…Randomised controlled trials (RCTs) have shown compression therapy to be effective [5], but healing can take many months (approximate median healing time is 12 weeks) [6]. Compression therapy is not always well tolerated by patients since it can be painful and inconvenient; bulky bandages may restrict ankle movement and cause difficulty in wearing shoes [7]. This may affect compliance to the treatment, which can consequently jeopardise its effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Aspirin versus placebo for the treatment of venous leg ulcers—a phase II, pilot, randomised trial (AVURT)

Tilbrook

Cook

Clark

et al. 2019

Trials

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Background Venous leg ulcers (VLUs) can take many months to heal and 25% fail to heal. The main treatment for venous leg ulcers is compression therapy and few additional therapies exist. Two previous trials indicated that low-dose aspirin may improve healing time, but these trials were insufficiently robust. Methods A multi-centred, pilot, phase II, randomised, double blind, parallel-group, placebo-controlled, efficacy trial (RCT) was conducted to determine: if aspirin improves VLU healing time; the safety of aspirin in this population; treatment compliance; and the feasibility of recruitment to a phase III trial. We recruited patients from secondary care who were aged ≥ 18 years, had a chronic VLU and not regularly taking aspirin. Participants were randomly assigned (1:1) to receive 300 mg of daily aspirin or placebo in addition to standard care, which consisted of multi component compression therapy aiming to deliver 40 mmHg at the ankle where possible. The randomisation list was stratified by ulcer size (≤ 5 cm 2 or > 5 cm 2 ). The primary endpoint was time to ulcer healing, which was defined as ‘complete epithelial healing in the absence of scab (eschar) with no dressing required’. Safety outcomes were assessed in all participants who received at least one dose of the study drug. Results Twenty-seven patients were recruited from eight sites (target 100 patients). A short time-frame to recruit and a large number of patients failing to meet the eligibility criteria were the main barriers to recruitment. There was no evidence of a difference in time to healing of the reference ulcer following adjustment for log ulcer area and duration (hazard ratio 0.58, 95% confidence interval 0.18 to 1.85; p = 0.357). One expected serious adverse event related to aspirin was recorded. A number of options to improve recruitment were explored. Conclusions There was no evidence that aspirin was effective in expediting the healing of chronic VLUs. However, the analysis was underpowered due to the low number of participants recruited. The trial design would require substantial amendment in order to progress to a phase III (effectiveness) trial. Trial registration Clinicaltrials.gov, NCT02333123 . Registered on 5 November 2014.

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“…Published research on SSTI among PWID in the UK is primarily epidemiological, demonstrating population and health care burden [ 7 , 12 , 13 , 21 , 32 , 33 ], but providing little insight into reasons for delayed care access. The scant UK qualitative literature addressing injecting-related SSTI focuses on venous ulcers [ 22 , 34 ]. To date, no published studies have focused on the barriers and facilitators to timely SSTI care access among PWID in the UK.…”

Section: Introductionmentioning

confidence: 99%

‘Care and Prevent’: rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

et al. 2018

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BackgroundSkin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID.MethodsCare and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1–P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study.ResultsWe are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK.ConclusionsCare and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.Electronic supplementary materialThe online version of this article (10.1186/s12954-018-0233-y) contains supplementary material, which is available to authorized users.

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The ghost of Nora Batty: A qualitative exploration of the impact of footwear, bandaging and hosiery interventions in chronic wound care

Cited by 8 publications

References 22 publications

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation

Aspirin versus placebo for the treatment of venous leg ulcers—a phase II, pilot, randomised trial (AVURT)

‘Care and Prevent’: rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

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