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Objective: Wound care is an important component of nursing care, consuming a significant amount of working hours. Literature reports the existence of many barriers to evidence-based wound care and that nursing students have an increasing need for education in this field. While blended learning activities have shown some benefits in learning outcomes, dedicated wound care modules within baccalaureate nursing courses occur infrequently. The aim of this study was to facilitate an increase in confidence and knowledge of evidence-based wound care in third-year baccalaureate nursing students. Method: In this descriptive pre–post research design, a dedicated wound care module within a baccalaureate nursing course (using a constructivist learning approach) was offered to students in a university in Australia. Pre- and post-implementation surveys were completed (2018–2020). Due to a small number of matching participants, only descriptive statistics were calculated for all variables. Results: A total of 276 students were invited to respond to the survey and 41 responded initially, 35 responded post the wound care module, and 26 responded to the survey after six months. Positive outcomes were noted in increased levels of confidence in the student nurses' ability to assess, manage and prevent wounds; as well as to apply evidence-based practice and change management following the educational wound care module within the baccalaureate nursing course. Conclusion: Implementation of a dedicated wound care module within a baccalaureate nursing course in this sample of third-year students fostered a positive change in the knowledge of evidence-based wound management, assessment and prevention. Education of the next generation of registered nurses in this valuable area of practice is an important part of baccalaureate nursing education. [ABSTRACT FROM AUTHOR]

Objective: A feasibility study to test the proposed methodology for a larger randomised control trial was conducted, investigating the comparative effectiveness of the two types of pressure management support surfaces with regards to healing pressure injuries (PI). A secondary objective was to provide insights into the user acceptability of the two types of pressure management support surfaces. Method: A randomised control feasibility study was conducted in a community health setting in Canberra, Australia. Patients aged ≥65 years with an existing Stage 2 PI who slept in a bed were eligible. Participants were randomised to either the active mattress group or the reactive mattress group for use on their bed. All participants received standard wound care by community nursing staff and were provided an air-flotation cushion for use when not in bed. Photographs were taken and used for blind assessment of wound healing. Secondary information was gathered through a survey regarding user acceptability of the support surfaces and changes in habits regarding PI prevention strategies. Results: In total, five patients were recruited, with one passing away prior to mattress allocation. Results were inconclusive with regards to comparative effectiveness and user acceptability due to the small sample size; however, secondary data indicated an increasing implementation of PI prevention strategies. Conclusion: This study confirmed the need for further high quality research comparing reactive and active pressure mattresses. Trends indicate the importance of including education on PI prevention strategies to promote changes in behaviour. Changes to the proposed methodology will be made to increase recruitment in the primary study. [ABSTRACT FROM AUTHOR]

Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18–86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration. [ABSTRACT FROM AUTHOR]

Decolonial perspectives on art history have elaborated on the ways visual representations and documentary media are intertwined with the colonial project. The visual regime is associated with the coloniser's Eurocentric, objectifying and territorialising gaze. Can the visual still play a part in healing colonial wounds? The Karrabing Collective, a majority Indigenous group based in the Northern Territories of Australia, seems to engage with this question. Studying their video art as a form of invitation, I question how these works address inhospitable zones in the imaginations of the modern world and settler-colonial legacies. Extending Donna Haraway's metaphor of visiting as a mode of ethical attention, I posit that these works destabilise Western understandings of hospitality, memory, and image-making. I argue that their re-visiting of settler-colonial encounters rejects the primacy of archival integration and access, inviting the viewer to visit the lived space of peripheral vision that shifts between remembering and re-imagining. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes‐related foot disease (DFD) — foot ulcers, infection, ischaemia — is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence‐based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC. Main recommendations: This article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including: prevention — screening, education, self‐care, footwear, and treatments to prevent DFD;classification — classifications systems for ulcers, infection, ischaemia and auditing;peripheral artery disease (PAD) — examinations and imaging for diagnosis, severity classification, and treatments;infection — examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments;offloading — pressure offloading treatments for different ulcer types and locations; andwound healing — debridement, wound dressing selection principles and wound treatments for non‐healing ulcers. Changes in management as a result of the guideline: For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self‐monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD. [ABSTRACT FROM AUTHOR]

Objective: It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. Method: A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. Results: In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (β=–0.776, p=0.013); hospital site (β=–0.702, p=0.025); and number of postoperative days (β=–0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6–10.3% of variance in the postoperative wound care education patients received. Conclusion: Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed. [ABSTRACT FROM AUTHOR]

Objective: Pain is a complex symptom associated with hard-to-heal (chronic) leg ulcers that is often poorly managed. The objective of this study was to gain greater understanding by investigating relationships between physical and psychosocial factors, and pain severity in adults with hard-to-heal leg ulcers. Method: A secondary analysis of data collected for a longitudinal, observational study of adults with hard-to-heal leg ulcers was undertaken. Data were collected over a 24-week period, including variables relating to sociodemographics, clinical variables, medical status, health, ulcer and vascular histories, and psychosocial measures. Multiple linear regression modelling was used to determine the independent influences of these variables on pain severity, as measured with a Numerical Rating Scale (NRS). Results: Of 142 participants who were recruited, 109 met the inclusion criteria for this study, of whom: 43.1% had venous ulcers; 41.3% had mixed ulcers; 7.3% had arterial ulcers; and 8.3% had ulcers from some other cause. The final model explained 37% (adjusted r2=0.370) of the variation in the pain NRS scores. Controlling for analgesic use, salbutamol use (p=0.005), clinical signs of infection (p=0.027) and ulcer severity (p=0.001) were significantly associated with increased pain, while the presence of diabetes (p=0.007) was significantly associated with a decrease in pain. Conclusion: Pain is a highly complex and pervasive symptom associated with hard-to-heal leg ulcers. Novel variables were identified as being associated with pain in this population. The model also included wound type as a variable; however, despite being significantly correlated to pain at the bivariate level of analysis, in the final model, the variable did not reach significance. Of the variables included in the model, salbutamol use was the second most significant. This is a unique finding that, to the authors' knowledge, has not been previously reported or studied. Further research is required to better understand these findings and pain in general. [ABSTRACT FROM AUTHOR]

Introduction: Tinospora smilacina is a native plant used in traditional medicine by First Nations peoples in Australia to treat inflammation. In our previous study, an optimised Calophyllum inophyllum seed oil (CSO) nanoemulsion (NE) showed improved biomedical activities such as antimicrobial, antioxidant activity, cell viability and in vitro wound healing efficacy compared to CSO. Methods: In this study, a stable NE formulation combining T. smilacina water extract (TSWE) and CSO in a nanoemulsion (CTNE) was prepared to integrate the bioactive compounds in both native plants and improve wound healing efficacy. D-optimal mixture design was used to optimise the physicochemical characteristics of the CTNE, including droplet size and polydispersity index (PDI). Cell viability and in vitro wound healing studies were done in the presence of CTNE, TSWE and CSO against a clone of baby hamster kidney fibroblasts (BHK-21 cell clone BSR-T7/5). Results: The optimised CTNE had a 24 ± 5 nm particle size and 0.21± 0.02 PDI value and was stable after four weeks each at 4 °C and room temperature. According to the results, incorporating TSWE into CTNE improved its antioxidant activity, cell viability, and ability to promote wound healing. The study also revealed that TSWE has > 6% higher antioxidant activity than CSO. While CTNE did not significantly impact mammalian cell viability, it exhibited wound-healing properties in the BSR cell line during in vitro testing. These findings suggest that adding TSWE may enhance CTNE's potential as a wound-healing treatment. Conclusion: This is the first study demonstrating NE formulation in which two different plant extracts were used in the aqueous and oil phases with improved biomedical activities. [ABSTRACT FROM AUTHOR]

Objective: Diabetes‐related foot ulceration (DFU) is a common limb‐threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes‐related foot ulceration in an Australian population. Research design and methods: This was a prospective cohort study of individuals with diabetes‐related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio‐economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire‐short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. Results: A total of 117 participants were included. The majority were male n = 96 (82%), socio‐economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2, SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28–14.84, p = 0.02), and greater levels of socio‐economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01–1.02, p = 0.03). Conclusions: In this cohort study of predominantly neuropathic, non‐infected DFU, individuals who had greater levels of socio‐economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal. [ABSTRACT FROM AUTHOR]

Background: More than 2.5 million people are admitted for surgery in Australia each year, and between 40 to 80% will experience moderate to high preoperative anxiety. Elevated levels of preoperative anxiety can increase the risk of postoperative complications such as pain, delayed wound healing, infection, prolonged recovery, and longer hospitalisation. Limited previous research on Virtual Reality (VR) indicates a positive impact on surgery-related anxiety and suggests that the intervention potentially leads to reduce postoperative complications.Objective: To evaluate the effectiveness of using VR technology for perioperative anxiety among adults undergoing elective surgery.Method: A two-group parallel randomised controlled trial (RCT) will be conducted, including 150 adult patients (aged 18 years and over) undergoing elective surgery and requiring an overnight stay at a major metropolitan hospital. Eligible participants will be screened for anxiety via the Amsterdam Preoperative Anxiety and Information score (APAIS). Those with moderate to severe anxiety will be randomly allocated to receive the VR session or usual care, in the preoperative holding area. Intervention participants will use a head-mounted VR device to watch and listen to a nature scene for 10 minutes.Study Outcomes: The primary outcome is perioperative anxiety measured using the visual analogue scale for anxiety (VAS-A). Secondary outcomes include stress levels (measured by saliva cortisol level and heart rate), postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events.Conclusion: This study will help evaluate if a brief preoperative VR session can reduce perioperative anxiety for adult elective surgical patients.Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001350910. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related foot ulceration (DFU) has a substantial burden on both individuals and healthcare systems both globally and in Australia. There is a pressing need for updated guidelines on wound healing interventions to improve outcomes for people living with DFU. A national expert panel was convened to develop new Australian evidence-based guidelines on wound healing interventions for people with DFU by adapting suitable international guidelines to the Australian context. Methods: The panel followed National Health and Medical Research Council (NHMRC) procedures to adapt suitable international guidelines by the International Working Group of the Diabetic Foot (IWGDF) to the Australian context. The panel systematically screened, assessed and judged all IWGDF wound healing recommendations using ADAPTE and GRADE frameworks for adapting guidelines to decide which recommendations should be adopted, adapted or excluded in the Australian context. Each recommendation had their wording, quality of evidence, and strength of recommendation re-evaluated, plus rationale, justifications and implementation considerations provided for the Australian context. This guideline underwent public consultation, further revision and approval by ten national peak bodies. Results: Thirteen IWGDF wound healing recommendations were evaluated in this process. After screening, nine recommendations were adopted and four were adapted after full assessment. Two recommendations had their strength of recommendations downgraded, one intervention was not currently approved for use in Australia, one intervention specified the need to obtain informed consent to be acceptable in Australia, and another was reworded to clarify best standard of care. Overall, five wound healing interventions have been recommended as having the evidence-based potential to improve wound healing in specific types of DFU when used in conjunction with other best standards of DFU care, including sucrose-octasulfate impregnated dressing, systemic hyperbaric oxygen therapy, negative pressure wound therapy, placental-derived products, and the autologous combined leucocyte, platelet and fibrin dressing. The six new guidelines and the full protocol can be found at: https://diabetesfeetaustralia.org/new-guidelines/ Conclusions: The IWGDF guideline for wound healing interventions has been adapted to suit the Australian context, and in particular for geographically remote and Aboriginal and Torres Strait Islander people. This new national wound healing guideline, endorsed by ten national peak bodies, also highlights important considerations for implementation, monitoring, and future research priorities in Australia. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related foot ulceration (DFU) has a substantial burden on both individuals and healthcare systems both globally and in Australia. There is a pressing need for updated guidelines on wound healing interventions to improve outcomes for people living with DFU. A national expert panel was convened to develop new Australian evidence-based guidelines on wound healing interventions for people with DFU by adapting suitable international guidelines to the Australian context. Methods: The panel followed National Health and Medical Research Council (NHMRC) procedures to adapt suitable international guidelines by the International Working Group of the Diabetic Foot (IWGDF) to the Australian context. The panel systematically screened, assessed and judged all IWGDF wound healing recommendations using ADAPTE and GRADE frameworks for adapting guidelines to decide which recommendations should be adopted, adapted or excluded in the Australian context. Each recommendation had their wording, quality of evidence, and strength of recommendation re-evaluated, plus rationale, justifications and implementation considerations provided for the Australian context. This guideline underwent public consultation, further revision and approval by ten national peak bodies. Results: Thirteen IWGDF wound healing recommendations were evaluated in this process. After screening, nine recommendations were adopted and four were adapted after full assessment. Two recommendations had their strength of recommendations downgraded, one intervention was not currently approved for use in Australia, one intervention specified the need to obtain informed consent to be acceptable in Australia, and another was reworded to clarify best standard of care. Overall, five wound healing interventions have been recommended as having the evidence-based potential to improve wound healing in specific types of DFU when used in conjunction with other best standards of DFU care, including sucrose-octasulfate impregnated dressing, systemic hyperbaric oxygen therapy, negative pressure wound therapy, placental-derived products, and the autologous combined leucocyte, platelet and fibrin dressing. The six new guidelines and the full protocol can be found at: https://diabetesfeetaustralia.org/new-guidelines/ Conclusions: The IWGDF guideline for wound healing interventions has been adapted to suit the Australian context, and in particular for geographically remote and Aboriginal and Torres Strait Islander people. This new national wound healing guideline, endorsed by ten national peak bodies, also highlights important considerations for implementation, monitoring, and future research priorities in Australia. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods: We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel's and international guideline's judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results: We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion: New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia. [ABSTRACT FROM AUTHOR]

Aim: To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. Methods: A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. Design: Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. Results: A sample of 143 participants was recruited (51% male, M age = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks (SE 1.63, 95% CI 33.7–40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications (p =.035), presence of haemosiderosis (p =.006), decreased mobility (longer sitting times) (p =.007) and lower social support scale scores (p =.002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance (p =.06). Conclusion: Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention. [ABSTRACT FROM AUTHOR]

Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30 %. We conducted a randomised, inactive-placebo controlled, double-blind trial of 500 mg of slow-release vitamin C in sixteen people with foot ulcers in the Foot Wound Clinic at Westmead Hospital. Nine were randomised to control and seven to vitamin C. When serum vitamin C results become available at 4 weeks, all people with deficiency were offered both vitamin C and glucosamine tablets for the next 4 weeks. Patients without baseline deficiency continued their original assigned treatment. The primary outcome was percentage ulcer healing (reduction in ulcer size) at 8 weeks. Fifty percentage of subjects had baseline vitamin C deficiency, half having undetectable levels. Healing at 8 weeks was significantly better in the vitamin C group (median 100 v. –14 %, P = 0·041). Healing without amputation occurred in all patients in the vitamin C group. In contrast, 44 % of controls had not healed their ulcer at the end of the study period. Vitamin C improved healing of foot ulcers. Further studies are needed to determine whether there is a threshold effect for serum vitamin C above which therapy is ineffective and whether there are better or lesser responding subgroups. Because of its low cost and ease of access and administration, we recommend offering vitamin C therapy to all people who have chronic foot ulcers and potentially suboptimal vitamin C intake. Trial registration number: ACTRN12617001142325. [ABSTRACT FROM AUTHOR]

Recently, a wound dressing formulation, (Tri‐Solfen®, Medical Ethics Pty Ltd, Australia; TS) registered for use in ruminant husbandry in Australia, was registered for Foot‐and‐Mouth Disease (FMD) therapy in large ruminants in Laos, following clinical observations of improved welfare and healing following treatment of FMD lesions. In November 2019, an FMD outbreak in Cameroon provided an opportunity for a field trial, comparing clinical responses and recoveries to treatments on a sample of cattle (n = 36) comprising three equal groups of animals (n = 12), comparing responses to three treatments: (i) the application to lesions of TS, (ii) the administration of parenteral oxytetraycline commonly used for FMD in Cameroon; and (iii) an untreated control group (C). Appetite scores, lesion healing scores, and changes in dimensions of lesions, were recorded over a 15‐day study period. Cattle treated with TS achieved both superior appetite and lesion healing scores with more rapid reduction in dimensions of lesions than other groups. Farmer observations indicated the TS treatment group had a more rapid return to eating with cessation of excessive salivation, and more rapid return of mobility (walking) with absence of overt lameness. The findings indicate that although mortality is usually low in FMD outbreaks, the disease is a debilitating and painful disorder with negative animal welfare impacts that should be addressed. All farmers expressed their desire that the product be made available for use in their region and modelling indicates that TS therapy imposes no additional financial burden on farmers, with the treatment likely to be provided at a similar or reduced cost to current treatment choices. As use of antibiotics for treatment of a viral disease potentially increases pressures for development of antimicrobial resistance and residues in the food chain, TS as an alternative non‐antimicrobial therapy should be promoted for wider use in FMD outbreaks. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery. Background: Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment. Design: Descriptive, qualitative study. Methods: Eighteen patients with chronic wounds from three wound services were engaged in semi‐structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model. Results: Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight. Conclusions: The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital. Relevance to clinical practice: Shared care between specialist and primary care should include evidence‐based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient‐held wound plans and upskilling of frontline clinicians. [ABSTRACT FROM AUTHOR]

Objective: Intensive care unit (ICU) patients possess multiple risk factors for developing loss of skin integrity, particularly incontinence-associated dermatitis (IAD). IAD is an inflammatory skin condition resulting from repeated and prolonged contact with urine, faeces or both. This study aimed to measure the incidence and clinical characteristics of adult ICU patients with IAD. Method: This was a prospective observational study conducted over three months in an adult ICU. Included patients were ≥18 years who experienced faecal incontinence during their intensive care admission. Patients were excluded if they had an ileostomy or colostomy, had IAD on admission, or were continent of urine and faeces. Skin inspections were performed every second day on all recruited patients by trained research nurses. Other data were collected from patient medical records. Results: A total of 37 patients took part in the study. Incidence of IAD was 35.1%; 13 patients who had incontinence developed IAD. The mean time to onset of IAD was 3.69 days, median 3 days (SD: 1.8, range: 2–8 days). Of the 13 patients who developed IAD, 12 (92.3%) patients were initially assessed as having category 1 IAD and one (7.7%) patient was initially assessed with category 2 IAD. Of the patients with category 1 IAD, one patient (7.7%) progressed to category 2 IAD severity. Conclusion: A larger sample is recommended to fully explore ICU patient characteristics and IAD development. The incidence of IAD in ICU patients was high at 35%, indicating this condition requires due consideration in ICU patients. [ABSTRACT FROM AUTHOR]

Wound healing is an essential biological process which involves tissue repair and recovery and includes the action of a complex system of blood cells, cytokines, and growth factors. It is a process attended by integrated cellular and biochemical events and characterized by four phases: haemostasis, inflammation, proliferation, and remodelling. Medicinal plants which have healing applications, continue to play a central role in the healthcare system of a large proportion of the world's population. Numerous studies have shown that several Australian plant species used medicinally, contain biologically active extracts and compounds which have enormous potential for the treatment and management of a wound. Medicinal plants contain a wide range of chemical compounds as the unique flora of Australia offers an array of diverse bioactives, which elicit antibacterial, antioxidant, anti-inflammatory and wound healing abilities. Such properties are not limited to the edible sections of plants as the roots, bark, sap, leaves and seeds from a vast array of plants have demonstrated similar effects. In this review article, various Australian native plants which are scientifically proven to have antibacterial and anti-inflammatory properties that support wound healing, are discussed. This review also briefly discusses the general wound healing process, wound-colonizing bacteria, factors that affect wound healing, and costs involved in the treatment and management of chronic wounds. [ABSTRACT FROM AUTHOR]

INTRODUCTION Perineal trauma is a commonly observed complication of childbirth, affecting more than 75% of women who have a vaginal birth. Perineal trauma is associated with significant short- and long-term comorbidities that negatively impact women’s quality of life. Severe perineal trauma (SPT) rates in Australia have almost doubled in the last decade. Reasons for increased rates are not completely understood; some researchers suggest improvements in diagnosis and reporting, while others have a view that it may be due to a lack of structured and standardized education in perineal wound assessment and repair for clinicians. METHODS The Joanna Briggs Institute (JBI) scoping review methodology was adopted as a systemic process to identify studies that have investigated the effectiveness of perineal wound assessment and repair education and training for midwives and midwifery students. RESULTS Five studies met the inclusion criteria for this review, to have evaluated a type of education or training, on childbirth-related perineal wound assessment and repair that included midwives and midwifery students. A total of 1279 midwives and midwifery students volunteered to participate in all five studies. The length of the education or training implemented varied between each study from a 1-day workshop to 100 hours of education. All five studies measured the effectiveness of each program through changes in participants’ confidence, knowledge and skills in perineal assessment and repair before and after an intervention using various self-assessment questionnaires. CONCLUSIONS The implementation of a structured educational workshop on perineal wound assessment and repair improves the confidence, skills and knowledge of midwives and students. [ABSTRACT FROM AUTHOR]

To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association.)

Objective: To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. Method: Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. Results: The median length of hospital stay was 14 days (1–70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. Conclusion: Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. [ABSTRACT FROM AUTHOR]

Mechanical debridement can be considered as an alternative to surgical debridement if surgery is not available, or is considered impractical or too high risk. One form of selective mechanical debridement is ultrasonic-assisted wound (UAW) debridement. As the published evidence on this is limited, a closed international expert meeting was held to review the existing evidence base on it, present preliminary findings of research currently in progress and discuss individual cases selected from the clinical experts' own practice. The panel also explored the potential barriers to the implementation of UAW debridement and how these might be addressed. It concluded there is sufficient evidence that UAW debridement is an effective method of cleansing and debriding almost all hard-to-heal wounds. Patients who are most likely to benefit from it are not medically stable, on anticoagulants, unable to visit a hospital for wound treatment, and/or have wounds with a poor vascular supply or are close to critical structures. The panel also observed that UAW debridement can be used to prepare the wound for negative pressure wound therapy (NPWT) or as an adjunctive to it. Given the potential to experience pain during the procedure, the panel considered that patients will benefit from topical analgesia. The panel noted that health professionals, patients and visitors must be protected from the aerosolisation associated with UAW, to reduce risk of cross-contamination. [ABSTRACT FROM AUTHOR]

Background: Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children., Methods and Analysis: A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft., Ethics and Dissemination: Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx)., Trial Registration Number: Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx]., Competing Interests: Competing interests: Co-investigators of the study are paediatric burns surgeons (RMK, CAM, BP) treating participants at the study site. However, these surgeons will not have any role in the participant recruitment, allocation to groups. The BBSIP was developed by two of the authors (ZT, RMK) and is used as standard of care at the study site., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digital wound application (app) for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the app as easy to use. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.

Compression therapy is the current evidence‐based approach to manage venous leg ulcers (VLU); however, adherence is a major barrier to successful treatment. Combination approaches may relieve the burden of treatment by shortening the time to ulcer healing. This scoping review conducted by Australian researchers aimed to establish the evidence of effectiveness of various adjuvant methods on wound healing and recurrence. Randomized Controlled Trials (RCTs), and Systematic Reviews (SR) and Meta‐Analyses (MA) on VLU management approaches published from January 2015 to December 2018 were included in this review. The articles included in the scoping review were grouped according to the management approaches, including (1) pharmaceutical interventions, (2) surgical interventions, (3) topical agents, (4) the use of devices, and (5) other, such as physiotherapy and psychological interventions. Results of this scoping review indicate that there is a limited high‐quality evidence of effectiveness in most adjuvant therapies on wound healing and recurrence. Given the low‐quality evidence observed in this scoping review for adjuvant treatments, the implication for practice is that current management guidelines be followed. Further rigorous studies have the potential to produce better quality evidence. Quality of evidence can be improved by ensuring large sample sizes of a single etiology wounds, standardizing reporting outcomes, and maintaining detailed and evidence‐based protocols in physiological or psychological interventions. [ABSTRACT FROM AUTHOR]

With the demonstration of the effectiveness of antibiotic treatment, the management of Mycobacterium ulcerans disease has changed from a predominantly surgically to a predominantly medically treated disease. However, research among Australian patients has revealed that antibiotic treatment alone is associated with prolonged wound healing times, high rates of treatment toxicity, and the potential for significant tissue destruction associated with severe paradoxical reactions. We present the current state of M. ulcerans management in Barwon Health, Australia, where a close working relationship exists between the Plastic Surgical and Infectious Diseases units. Here treatment has evolved based on nearly 20 years of experience gained from managing more around 600 patients from a M. ulcerans epidemic on the nearby Bellarine and Mornington Peninsulas. In our experience, surgery has re‐emerged to play an important role in the treatment of M. ulcerans in improving the rate of wound healing, minimizing antibiotic associated toxicity and preventing further tissue loss associated with severe paradoxical reactions. For selected small lesions surgery without antibiotics may also be an effective treatment option, however aggressive surgical resection of lesions with wide margins through uninvolved tissue should no longer be performed. Furthermore, extensive excisional surgery that will require the use of split skin grafts and vascularized tissue flaps to repair skin defects should be avoided if possible. [ABSTRACT FROM AUTHOR]

Evidence translation in wound care relies on the need for evidence generation. Clinical practice may generate evidence only if evidence‐generating research projects, such as randomised controlled trials (RCTs), became routinised in clinical settings. The aim of this study was to identify optimal trial‐related practices to routinise trial‐related activities in Melbourne‐located wound clinics as reported by clinicians and researchers. We conducted a secondary analysis of the available data on how to routinise RCTs in clinical care, with a focus on enablers and suggestions provided by the participants during face‐to‐face and telephone interviews. Data were obtained from a qualitative observational study nested within a randomised, double‐blinded, placebo‐controlled trial on clinical effectiveness of aspirin as an adjunct to compression therapy in healing chronic venous leg ulcers (ASPiVLU). We developed a seven‐step Routinisation of Trials in Clinical Care Framework. These steps include: (1) pre‐trial clinical site assessment, (2) optimising pre‐recruitment arrangements, (3) developing and updating trial‐related skills, (4) embedding RCT recruitment as part of routine clinical care, (5) promoting teamwork and trial‐related collaboration, (6) addressing trial‐related financial issues, and (7) communicating trial results to clinicians. [ABSTRACT FROM AUTHOR]

Chronic wounds are a significant problem in Australia. The health care‐related costs of chronic wounds in Australia are considerable, equivalent to more than AUD $3.5 billion, approximately 2% of national health care expenditure. Chronic wounds can also have a significant negative impact on the health‐related quality of life of affected individuals. Studies have demonstrated that evidence‐based care for chronic wounds improves clinical outcomes. Decision analytical modelling is important in confirming and applying these findings in the Australian context. Epidemiological and clinical data on chronic wounds are required to populate decision analytical models. Although epidemiological and clinical data on chronic wounds in Australia are available, these data have yet to be systematically summarised. To address these omissions and clarify the state of existing evidence, we conducted a systematic review of the literature on key epidemiological and clinical parameters of chronic wounds in Australia. A total of 90 studies were selected for inclusion. This paper presents a synthesis of the evidence on the prevalence and incidence of chronic wounds in Australia, as well as rates of infection, hospitalisation, amputation, healing, and recurrence. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) result in substantial economic costs and reduced quality of life (QoL); however, there are few Australian cost estimates, especially using patient‐level data. We measured community‐setting VLU management costs and the impact on the QoL of affected individuals. VLU patients were recruited from a specialist wound clinic, an outpatient clinic, and two community care clinics in Queensland. Cost data were collected at the baseline visit. QoL (EQ‐5D‐5L) and wound status data were collected at baseline, 1, 3, and 6 months. Patients were classified into guideline‐based/optimal care and usual care groups. Average weekly costs per patient were statistically significantly different between the usual care and optimal care groups—$214.61 and $294.72, respectively (P = 0.04). Baseline average QoL score for an unhealed ulcer was significantly higher in the optimal care group compared with usual care (P = 0.025). Time to healing differed between the usual care group and the optimal care group (P = 0.04), with averages of 3.9 and 2.7 months, respectively. These findings increase the understanding of the costs, QoL, and healing outcomes of VLU care. Higher optimal care costs may be offset by faster time to healing. This study provides data to inform an economic evaluation of guideline‐based care for VLUs. [ABSTRACT FROM AUTHOR]