Assessing pain at wound dressing-related procedures

This article is an abstract from a new guide, Principles of Best Practice: Minimising Pain at Wound Dressing-Related Procedures. It is an educational initiative of the World Union of Wound Healing Societies (WUWHS). The guide has been inspired by two seminal documents: the European Wound Management Association's position document, Pain at Wound Dressing Changes (EWMA, 2002), and Practical Treatment of Wound Pain and Trauma: A Patient-centred Approach (Reddy et al, 2003). As an international educational initiative, the WUWHS document is aimed at anyone involved in dressing-related procedures anywhere in the world. This article summarises the section on best practice in the assessment of wound pain.     

‘What works here doesn’t work there’: The significance of local context for a sustainable and replicable asset‐based community intervention aimed at promoting social interaction in later life

Interventions that harness local assets to benefit a community are increasingly being promoted to improve health and well‐being. In practice, we know little about how local contexts or reliance on local resources affect the sustainability and scalability of asset‐based community developments. This qualitative case study documents the development and implementation of a novel asset‐based community development project. Based in a large mainly rural county in North East England with relatively high levels of socioeconomic deprivation, the project aimed to prevent social isolation among older people, using a range of food‐related activities. Twenty‐one semi‐structured interviews were conducted with service users, volunteers, project partners, project development workers and senior staff. Interviews explored the project's design and implementation process, outcomes for participants and the wider community, and project sustainability and scalability. Thematic analysis of the data identified four factors likely to be important for creating sustainable and replicable asset‐based community projects. These factors are (a) recognising and harnessing assets among local people who may be otherwise marginalised due to age, geographical isolation and/or socioeconomic deprivation; (b) identifying assets that can be provided by local businesses; (c) genuine project co‐production to develop activities that meet local needs and inspire enthusiasm among all stakeholders; and (d) ongoing organisational support to meet the challenges to sustainability that exist in socioeconomically deprived areas. We conclude that successful asset‐based community projects require extensive community input and learning captured from existing programmes can facilitate the replicability of programmes in other community contexts.     

The Accelerating Access Initiative: experience with a multinational workplace programme in Africa

Problem

A multinational company with operations in several African countries was committed to offer antiretroviral treatment to its employees and their dependants.

Approach

The Accelerating Access Initiative (AAI), an initiative of six pharmaceutical companies and five United Nations’ agencies, offered the possibility of obtaining brand antiretroviral drugs (ARVs) at 10% of the commercial price. PharmAccess, a foundation aimed at removing barriers to AIDS treatment in Africa, helped to establish an HIV policy and treatment guidelines, and a workplace programme was rolled out from September 2001.

Local setting

Private sector employers in Africa are keen to take more responsibility in HIV prevention and AIDS care. An important hurdle for African employers remains the price and availability of ARVs.

Relevant changes

The programme encountered various hurdles, among them the need for multiple contracts with multiple companies, complex importation procedures, taxes levied on ARVs, lack of support from pharmaceutical companies in importation and transportation, slow delivery of the drugs, lack of institutional memory in pharmaceutical companies and government policies excluding the company from access to ARVs under the AAI.

Lessons learned

The launch of the AAI enabled this multinational company to offer access to ARVs to its employees and dependants. The private sector should have access to these discounted drugs under the AAI. A network of local AAI offices should be created to assist in logistics of drugs ordering, purchase and clearance. No taxes should be levied on ARVs.     

IGOB131, a novel seed extract of the West African plant Irvingia gabonensis, significantly reduces body weight and improves metabolic parameters in overweight humans in a randomized double-blind placebo controlled investigation

Background  

A recent in vitro study indicates that IGOB131, a novel seed extract of the traditional West African food plant Irvingia gabonensis, favorably impacts adipogenesis through a variety of critical metabolic pathways including PPAR gamma, leptin, adiponectin, and glycerol-3 phosphate dehydrogenase. This study was therefore aimed at evaluating the effects of IGOB131, an extract of Irvingia gabonensis, on body weight and associated metabolic parameters in overweight human volunteers.     

Variability of pressure provided by sustained compression

Compression therapy is the cornerstone of treatment for patients with venous leg ulcers (VLUs). Although it is generally accepted that the therapeutic outcomes are directly related to the quality of compression therapy, delivering precise and sustained compression therapy is an ongoing challenge for health care professionals. Several factors influence quality of compression therapy: physical structure and elastomeric properties of the compression system, size and shape of the leg, skill and technique of the bandager and physical activity undertaken by the patient. Graduated compression is achieved by applying a bandage at the same tension from ankle to knee, providing the shape of the leg is normal. Many patients with VLUs have distorted legs, challenging the delivery of a desired pressure gradient. Poor bandaging technique can result in little or no benefit or may deliver too high a pressure causing a detrimental effect to the wearer. If the wearer is unable to tolerate the compression, patient concordance and effectiveness are affected. Training has been shown to reduce variability of sub-bandage pressure. Sub-bandage pressure increases during standing and walking. These pressure changes are related to the elastomeric properties of the compression systems. Health care professionals need to understand the properties of the available compression systems and how their application technique must be adjusted.     

Leg ulceration in Portugal: quality of life

This study was undertaken to examine the impact of chronic leg ulceration on patients' health-related quality of life in an audit of practice in Lisbon, Portugal, and to observe the changes following 12 weeks of treatment. A questionnaire was administered at entry into an observational study and following 12 weeks of treatment. Patients entering the study were asked to complete the Nottingham Health Profile (NHP), Euroqol and visual analogue (VA) pain questionnaires at entry and after 12 weeks. Principal analysis compared final scores with those found at baseline and compared results with Portuguese normative data. In total, 98 patients entered the study and completed the initial questionnaire, with 68 (69.3%) patients completing the follow-up questionnaire. There were significantly (P < 0.001) higher scores for the patients compared with normative data for all domains of the NHP (all P < 0.001). Improvements were noted for all NHP scores after 12 weeks, although only bodily pain showed a significant improvement [mean difference (d) = 10.5, P = 0.003], with significant improvement also in Euroqol (d = 0.10, P = 0.027). Energy and social isolation improved substantially in the eight (11.8%) patients whose ulcers healed, but did not achieve statistical significance, although VA pain score did (d = 4.85, P < 0.001). Patients suffering from leg ulceration show modest improvements in perceived health following 12 weeks of usual care in Portugal. Improvements in practice may enhance the magnitude of these improvements.