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Wound digest


dressings and high compression. Debridement was suggested in 86%. For adjunctive measures, 80% advocated pentoxifylline and approximately 50% physiotherapy for improving ankle joint mobility. The majority emphasised the preventive value of compression stockings and surgical reduction of superficial venous hypertension.


n Treatment guidelines improve the consistency and quality of care, as well as reducing costs. The authors emphasise the need to produce a consensus document as this would give the guidelines greater influence.


O’Donnell Jr TF, M Balk E. The need for an Intersociety Consensus Guideline for venous ulcer.J Vasc Surg 2011; December (Suppl): 83S–90.


Pressure ulcers 3


Pressure-relieving support surfaces: a review of the evidence


Readability Relevance to daily practice Novelty factor


n This was a systematic review of articles that assessed the effects of pressure-relieving support surfaces in the treatment of pressure ulcers.


n The review included 18 randomised controlled trials of support surfaces for pressure ulcer treatment, involving 1309 participants.


n Of three trials comparing air-fluidised devices with conventional therapy, two reported significant reductions in pressure ulcer size but the lack of reported variance data meant that the results could not be replicated and verified.


n Three of the trials reported significant reductions in pressure ulcer size in low air loss devices compared with foam alternatives but the reviewers found no significant differences.


n No conclusive evidence about the superiority of any support surface for the treatment of existing pressure ulcers was found.


n The trials were found to have poor quality study conduct and design.


n Further study is required before firm conclusions about the most effective support surfaces to treat pressure ulcers can be drawn. At present the evidence base is inadequate.


McInnes E, Dumville JC, Jammali-Blasi A, Bell-Syer SEM. Support surfaces for treating pressure ulcers (Review). The Cochrane Library 2011; Issue 12


31 Wounds International Vol 3 | Issue 1 | ©Wounds International 2012 Diabetic foot ulcers 4


National diabetic foot care strategy in Scotland


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n A national strategy for diabetes foot care across Scotland has been developed by the Scottish Diabetes Foot Action Group (SDFAG).


n The national plan comprises patient information leaflets, education material and a consensus document for antibiotic use in the diabetic foot.


n Data collected indicate that 58% of Health Boards have consultants with dedicated foot clinics, and 42% had integrated orthotic involvement.


n SDFAG is working with Foot in Diabetes UK to identify key podiatry skills by developing core competencies and a competency framework for the diabetes podiatrist and diabetes orthotist.


n This national strategy aims to improve the quality of care for people with diabetes foot problems.


Leese GP, Stang D, Pearson DW, et al. A national approach to diabetes foot risk stratification and foot care. Scott Med J 2011; 56: 151–55.


5


Developing and validating a risk score for amputation


Readability Relevance to daily practice Novelty factor


n The authors sought to develop and validate a risk score to identify people hospitalised for diabetic foot infection who were at the highest risk of lower extremity amputation (LEA).


n A large clinical database was used to identify 3018 people hospitalised at 97 US hospitals between 2003 and 2007, 21.4% of whom underwent LEA.


n Risk factors most highly associated with LEA were: surgical site infection, previous LEA, vasculopathy, and white blood cell count >11000/mm3


(P<0.0001).


n The risk score stratified people into five groups, which showed a graded relation to LEA risk (P<0.0001).


n The authors concluded that this risk score appears to accurately stratify the risk of LEA in people hospitalised for diabetic foot infection.


Lipsky BA, Weigelt JA, Sun X, et al. Developing and validating a risk score for lower-extremity amputation in patients hospitalised for a diabetic foot infection.Diabetes Care 2011; 34: 1695–700.


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