The impact of postgraduate studies in wound healing on professional practice and personal development

There is some evidence to show that higher education can make a difference in nursing and midwifery programmes, however, there is a lack of evidence to demonstrate the effectiveness of postgraduate programmes with an inter-professional focus with regards to their impact on clinical practice. Between March and April 2017, a descriptive cross-sectional survey of graduates from a number of Master’s programme within the School of Medicine at Cardiff University was undertaken in order to determine the impact of postgraduate study on an individual’s professional practice and personal development. This article presents the results of the survey for the Masters in Wound Healing and Tissue Repair

A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well-being. Compression therapy is traditionally the “gold-standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub-bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold-standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers

The impact of postgraduate studies in wound healing on professional practice and personal development

There is some evidence to show that higher education can make a difference in nursing and midwifery programmes, however, there is a lack of evidence to demonstrate the effectiveness of postgraduate programmes with an inter-professional focus with regards to their impact on clinical practice. Between March and April 2017, a descriptive cross-sectional survey of graduates from a number of Master’s programme within the School of Medicine at Cardiff University was undertaken in order to determine the impact of postgraduate study on an individual’s professional practice and personal development. This article presents the results of the survey for the Masters in Wound Healing and Tissue Repair

Evidence-based review of the effects of nutritional supplementation for pressure ulcer prevention

The objective of this evidence-based review was to explore whether the evidence supports the use of nutritional supplements in pressure ulcer (PU) prevention strategies. Several electronic databases, including Ovid MEDLINE (1946 to May week 32 019), Ovid EMBASE (1947 to May 28, 2019), EBSCO CINAHL (until June 13, 2019), Scopus (until July 9, 2019), and the Web of Science (until June 13, 2019) were searched. No limitation was placed on the year of publication. Studies considered for inclusion were those with adult populations, and only English language texts with available full text were reviewed. AMSTAR (a measurement tool to assess systematic reviews) was used to evaluate the quality of the studies included in the systematic review. The Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence was used to assess the level of evidence. Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to assess guideline article, and Appraisal tool for Cross-Sectional Studies (AXIS) was also used for cross-sectional studies. The search identified 1761 studies. After the application of inclusion and exclusion criteria, 24 studies were retained of various designs, including 10 systematic reviews, five clinical reviews, three randomised controlled trials, two observational studies, one quasi-experimental study, one cross-sectional study, one cohort study, and one Clinical Guideline. Two were rated as high-quality reviews, 14 were rated as moderate-quality reviews, five were rated as low-quality reviews, and three were rated as critically low-quality reviews. The majority of the reviewed studies were of low-to-moderate quality because of biases in the study design and incomplete data reporting, which did not fulfil the reporting criteria of the appraisal tools. However, the majority of the studies showed a reduction in PU incidence after nutritional supplement though not significant. Whether the use of pharmacological appraisal tools to assess non-pharmacological studies is appropriate is unclear. Regardless of the low-to-moderate quality of the studies in this review, nutritional supplements appear to play a role in PU prevention

An explorative study on the validity of various definitions of a 2·2°C temperature threshold as warning signal for impending diabetic foot ulceration

Home monitoring of skin temperature is effective to prevent diabetic foot ulceration. We explored the validity of various definitions for the >2·2°C left-to-right threshold used as a warning signal for impending ulceration. Twenty patients with diabetes and peripheral neuropathy monitored their skin temperature with an infrared thermometer at the plantar hallux, metatarsal heads, midfoot and heel four times a day for 6 consecutive days. Environmental temperature and walking activity were monitored and associated with foot temperature. The average temperature difference between feet was 0·65°C. At single locations, a left-to-right temperature difference of >2·2°C was found 245 times (8·5% of measurements). Confirmation of these above-threshold readings on the following day was found seven times (0·3%). Corrected for individual left-to-right mean foot temperature differences, this reduced to four (0·2%). No ulcers developed in the week after monitoring. Left-to-right foot temperature differences were not significantly correlated with walking activity, environmental temperature or time of day. The >2·2°C left-to-right foot temperature threshold for impending ulceration is not valid as single measurement, but validity improves to acceptable levels when an above-threshold temperature difference is confirmed the following day and further improves with individual correction. The threshold is independent of time of day, environmental temperature and walking activity

The measurement properties of assessment tools for chronic wounds: a systematic review.

Background: Chronic wounds are an increasing problem in the aging population, patients experience a lower health-related quality of life and the care for these patients is associated with high costs. Thorough wound assessments facilitate objective monitoring of wound status and progress. A wound assessment tool can guide clinicians in these wound assessments and in recording wound progress or deterioration. Objective: Systematically identify assessment tools for chronic wounds, investigate their measurement properties, and summarize the data per assessment tool. Design: Systematic review. Methods: The databases Medline (PubMed interface), Embase, CINAHL, and CENTRAL were systematically searched until May 2020 (updated in February 2021). Studies reporting the development and/or the evaluation of measurement properties of assessment tools for chronic wounds were included. The “Consensus-based Standards for the selection of health Measurement Instruments” risk of Bias checklist was applied to evaluate the methodological quality of the included studies. Each reported measurement property was rated against criteria for good measurement properties. The evidence was summarized and the quality of the evidence was graded using a modified Grades of Recommendation, Assessment, Development, and Evaluation approach. Study selection, data extraction and quality appraisal were conducted independently by two reviewers and double-checked by a third reviewer. Results: Twenty-seven studies describing the measurement properties of fourteen assessment tools for chronic wounds were included. None of the studies reported a content validity evaluation by a relevance study or a comprehensiveness study in professionals. Six articles reported the development or revision of an existing assessment tool. The reported measurement properties included: structural validity (5 studies), reliability (18 studies), hypotheses testing for construct validity (18 studies) and responsiveness (7 studies). Internal consistency, cross-cultural validity / measurement invariance and measurement error were not reported. If criterion validity was assessed, the results were allocated to hypotheses testing for construct validity as no ‘gold standard’ is available. Conclusions: Fourteen assessment tools for chronic wounds were identified. Construct validity (by hypotheses testing) and responsiveness of the Pressure Ulcer Scale for Healing version 3.0 were supported by sufficient ratings based on moderate to high level quality of evidence. Reliability of the (Revised) Photographic Wound Assessment Tool had a sufficient rating based on moderate quality of evidence. The ratings of the measurement properties of the other wound assessment tools were either insufficient or indeterminate, or a sufficient result was supported by low to very low quality of evidence

Impact of postgraduate study on healthcare professionals' academic and clinical practice

Aims/Background Existing literature in the healthcare setting indicates that individuals enter higher education, particularly postgraduate programmes, to gain in-depth knowledge of a subject area, with a view to improving their career opportunities. Evidence also suggests that, in addition to perceived career enhancement, individuals also report benefits such as personal growth and broadening of perspectives, which have helped their clinical practice. The aim of this study was to examine the impact of postgraduate study on healthcare professionals' academic practice and discuss the potential links to improvements in clinical practice. Method This was a descriptive cross-sectional survey of a convenience sample of graduates from a range of postgraduate healthcare programmes at one UK university. A survey comprising 18 questions was designed to explore perceptions of impact and was distributed to 962 graduates with a response rate of 9.81% (n=98). Results The majority of respondents were doctors (n=54, 55.1%), women (n=59, 60.2%), based within the UK (n=36, 36.7%) and had completed their programme between 2014 and 2016 (n=72, 73.4%). With regards to achievements in professional practice, participants felt more confident in relation to research and evaluating evidence. In relation to impact on clinical practice, improvements in multidisciplinary team working as well as increased confidence emerged as main themes. Conclusions Findings support existing evidence in relation to the importance of postgraduate study, which is able to instil an increased sense of confidence in graduates' ability. This was particularly related to having a better understanding of speciality-related evidence and its application in clinical practice. This is something that previous studies do not seem to have reported and may reflect the multiprofessional nature of many of the postgraduate programmes provided

Linking extreme precipitation in Southeast Asia to equatorial waves

Equatorially trapped waves, such as Kelvin Waves, Equatorial Rossby Waves and Westward-moving Mixed Rossby-Gravity (WMRG) Waves, play a major role in organizing tropical convection on synoptic to sub-seasonal timescales. These waves have the potential to provide an important source of predictability for high impact weather in Southeast (SE) Asia and the tropics more widely. To aid understanding of the role played in high impact weather by such waves, the observed statistical relationship between identified equatorial waves and heavy rainfall in SE Asia is examined for the period 1998-2016. Increases in the amount of precipitation and the likelihood of extreme precipitation in SE Asia are linked to all three types of waves that are included in analysis; Kelvin, equatorial Rossby and WMRG waves. There is both increased mean rainfall and increased probability of occurrence of heavy rainfall on days when high amplitude waves propagate over SE Asia. In particular, heavy precipitation can be up to three times more likely in regions of SE Asia during equatorial waves, including Malaysia, Indonesia and the Philippines. Kelvin waves have a large influence on heavy rainfall over Indonesia, WMRG and Kelvin waves impact Malaysia rainfall, and equatorial Rossby and WMRG waves are linked to increased rainfall over the Philippines. Based on this study it can be concluded that the probability of extreme precipitation in this region is dependent on equatorial wave activity. Therefore, the skill in probabilistic prediction of extreme precipitation in SE Asia would be expected to be conditional on the skill in equatorial wave prediction, and the modelled relationship between equatorial waves and convection

Gambling harm as a global public health concern: A mixed method investigation of trends in Wales

Background: Recent research evidence has suggested that gambling is a public health concern. A number of studies report the association between gambling activity and increased instances of various other harms, including substance misuse and psychological disorders. In parallel to alcohol misuse, it is also becoming clear that gambling related harm is more of a continuum of harm, as opposed to traditionally accepted categorisations of gambling behavior: safe and responsible or “problem” and harmful. Previous effective treatment models for alcohol misuse have considered a public health approach to develop interventions. As such, the current research seeks to use a public health approach to both investigate the extent of gambling harm across Wales, and to identify upstream predictors of harm to inform future interventions. Method: A triangulation of data collection methods was utilized across Wales, UK. Two hundred and forty-eight participants completed a quantitative survey relating to gambling behavior and related harm, which included the Problem Severity Gambling Index, the Gambling Commission measure of frequency, The Gambling Motives Questionnaire and the Fast Alcohol Screening tool. Ninety-eight of these participants completed a qualitative subsection. Structured interviews were conducted with 20 individuals from 11 service providers. Semi-structured interviews were conducted for the five case studies of individuals who had previously sought help for gambling. The geographical density and distribution of Licensed Gambling Outlets was also mapped in local areas. Results: The findings provide further evidence of a continuum of gambling related harm. Twenty seven percent of survey participants demonstrate some indicators of risk of gambling harm. Social, cultural and environmental contexts play a role in initiation and maintenance of gambling behavior and the subsequent related harm. Accounts from individuals corroborated the quantitative findings. Conclusions: Findings from this Welsh sample are in line with and add support to the growing international research evidence that gambling harms are a universal issue that cross cultures. It is clear that action is needed by legislators at a policy level and that broadening the focus of intervention to a public health level is necessary to develop effective strategies for harm reduction