Addressing real world challenges for community nurses: active treatment for non-healing wounds

Community nurses play a vital role in the healthcare system, touching the lives of individuals across their lifespan. With a variety of job titles and opportunities for specialisation, these dedicated professionals continue to make a profound impact on patient care. This article will focus on district nurses and the challenges they face. It will also explore the impact non-healing wounds can have on patients and how implementing a comprehensive treatment pathway can effectively address the challenges encountered by community nurses in their day-to-day practice.

KEY WORDS

Community nurses;

Non-healing wounds;

Patient care;

Real world challenges

JEANETTE MILNE

Associate Director of Nursing Delivery; Northumbria Healthcare NHS Foundation Trust

This article and the best practice statement were sponsored by Smith+Nephew. The views presented in this document are the work of the author and do not necessarily reflect the views of Smith+Nephew.

ADA 2023: “An explosion” of promising innovations for type 2 diabetes and obesity

Aligned with the importance of weight management for people with type 2 diabetes, the American Diabetes Association (ADA) 83rd Scientific Sessions this year showcased new and existing drug treatments for obesity, some of which also provide significant glucose-lowering in people with type 2 diabetes. In the late-breaking Weight Loss Innovations session on 25 June, Dr Robert Gabbay, Chief Scientific and Medical Officer for the ADA, described “an explosion of promising new research and innovations in recent years”, and stated that the studies presented at this year’s annual meeting “are game changers in the way we customise treatment for individuals with obesity and those with type 2 diabetes”. In this report from the Sessions, Pam Brown highlights the latest developments in pharmacotherapy for weight loss and glucose lowering.

A patient-centric approach to compression therapy: the use and adoption of a novel mobile application to support the clinical selection of medical compression hosiery

It is widely acknowledged that compression therapy is an effective treatment option for the management of lower limb conditions; however, it is not always applied appropriately by clinicians. A lack of knowledge and clinical uncertainty, coupled with increased workload and reduced time with patients, can contribute to inappropriate decisions being made in regard to compression. This article investigates the adoption of the Hosiery Hunter® app (medi UK) and its role in guiding decision-making within clinical practice. The Hosiery Hunter® app is a novel mobile application designed to simplify the selection of medical compression hosiery for patients with lower limb conditions. Based on qualitative data from a user feedback survey, it was found that the Hosiery Hunter® app helped simplify the process of selecting the most appropriate compression therapy, saved time and provided quick and timely access to codes for prescription. All nurses surveyed agreed that they would continue using the app and would recommend it to a colleague. This article sheds light on the challenges clinicians face in the selection of compression therapy, and explores the effectiveness of adopting the Hosiery Hunter® app in support of providing appropriate, safe and effective care for all patients.

KEY WORDS

Chronic oedema

Compression

Mobile application

Venous insufficiency

GEORGINA RITCHIE Director of Education, Accelerate CIC

HAYLEY TURNER-DOBBIN Clinical Delivery Lead Wound Care, Research and Development, Accelerate CIC

A multidimensional approach to wound bed preparation using UrgoClean Ag

Background: Chronic wounds have a significant impact on patients’ lives and are challenging for healthcare professionals to treat. Failure to implement evidencebased practice can prolong patient suffering and lead to wound complications such as infection. Effective dressing selection is important to ensure wound bed preparation (WBP) and removal of the barriers to healing, such as devitalised tissue, infection, and excess exudate. Multidimensional products such as UrgoClean Ag have a combined action of continuous cleansing, debridement, and treatment of infection, and can effectively prepare the wound bed and advance wound healing. This paper discusses the importance of WBP, with a focus on infection and biofilm management using a multidimensional product (UrgoClean Ag), with clinical practice examples.

KEY WORDS

Biofilm

Infection

Multidimensional

products

UrgoClean Ag

Wound bed preparation

CAROLINE DOWSETT Clinical Nurse Specialist, Tissue Viability, East London NHS Foundation Trust.

A formal senior review process of data from a wound management digital system to identify wounds that may be on a deteriorating trajectory: a review

ABSTRACT: This service evaluation demonstrates how data from a digital wound management system could be used to improve healing rate trajectories for people with deteriorating wounds. Data entered by clinicians at the point of care was used to identify people who may have a deteriorating wound, enabling senior clinicians to provide a remote treatment plan without undertaking a face-to-face visit. This report provides a service-evaluation data from a Wound Management Digital System (WMDS) used to determine if wounds were improving or not. A formal ‘senior review’ process in the Podiatry Service was evaluated. We identified that 56% of people saw a reduction in their wound area following the review. This was compared with wounds that had been identified as deteriorating by the WMDS, but not formally reviewed, where 50% of wounds improved. This paper provides some early evidence on the effectiveness of a Senior Review process based on data output from a WMDS.

KEY WORDS

ehealth

Senior review

Telehealth

Wound management

Wound management digital system

MICHAEL OLIVER MSc, BSc (Hons) Podiatry, Programme Manager, Livewell Southwest

.JAYMIE STEPHENS, BSc (Hons) Podiatry, Foot Protection Lead Podiatrist, Livewell Southwest HANNAH BLAKE,

MDip, BSc (Hons), Tissue Viability Specialist Nurse, Livewell Southwest VIVIENNE TURTLE-SAVAGE, Digital and Data Lead for Wounds, Livewell Southwest

Reaching a XENITH in cardiorenal protection

Zibotentan, a developmental endothelin A receptor antagonist, in combination with dapagliflozin in SGLT2 inhibitor-naïve patients, was effective in reducing albuminuria in people with chronic kidney disease (CKD) already on optimised RAAS blockade in the XENITH-CKD trial published in the Lancet. In this randomised, active-controlled, phase 2b clinical trial, adults with CKD, an eGFR of ≥20 mL/min/1.73 m2 and a uACR of 150–5000 mg/g (approximately 17–565 mg/mmol) were randomised to 12 weeks of treatment with zibotentan 1.5 mg daily (high dose; N=179), zibotentan 0.25 mg (low dose; N=91) or placebo (N=177), all in combination with dapagliflozin 10 mg daily, and in addition to full doses of an ACE inhibitor or ARB if tolerated. At 12 weeks, compared with placebo, there was a significant 33.7% reduction in uACR in the high-dose zibotentan group and a 27% reduction in the low-dose group. Fluid retention had been identified in previous studies of endothelin A antagonists; therefore, weight and B-type natriuretic peptide were monitored during the study and demonstrated fluid retention event rates of 18% with high-dose zibotentan and dapagliflozin, 9% with low-dose zibotentan and dapagliflozin, and 8% with dapagliflozin alone.

Citation: Brown P (2023) Diabetes Distilled: Reaching a XENITH in cardiorenal protection. Diabetes & Primary Care 25: [Early view publication]