Abstract
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Abstract
The goals of the first phase of a broader wound management education and training project were to determine the education and training needs of health consumers and the relevant health workforce and to identify and map the available education and training activities and resources. The methods used to collect the data included online surveys and one-on-one interviews of relevant patients and their carers. The project manager actively sought to engage with the key wound management leaders and advanced clinicians to gain their support and views on the priority education and training issues. The response to all data collection methods was pleasing, with over 500 responses to the general wound workforce online survey. The data supported the need for more wound management education and training and identified some particular topics of need, such as utilising wound investigations and understanding wound products, pharmaceuticals and devices. The occupational groups with the highest need appear to be those working in primary health care, such as practice nurses and general practitioners (GPs), and those working in residential aged care facilities.
The education and training stocktake identified a wide range of activities currently available, the majority being provided in a face-to-face format. The next stage of the project will be to form some clear and achievable priority action areas based on the available data. An online directory of wound management education and training activities and resources will be developed and further development will be undertaken on a knowledge and skills framework for the wound management workforce. Additionally, transfer of learning factors in the general practice environment will be assessed and strategies will be developed to improve the pre-entry or undergraduate wound management training within relevant higher education programs.

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Question
Chronic wounds are an increasing cause of morbidity in Western countries with ageing populations. Medical education curriculum of undergraduate medical students should reflect this concern through effective teaching of wound healing and appropriate management of patients with chronic wounds. On the basis of available literature it is evident that at present education in chronic wounds is lacking in the undergraduate medical curriculum. The present study was undertaken to assess the level of knowledge and confidence about management of the chronic wound among students and interns. The results revealed that most of them felt that they had inadequate knowledge of best practice in chronic wound care before attending the wound clinic, and most agreed that attendance at a wound clinic was a useful learning opportunity. This study confirms that short placement in a dedicated wound clinic, with delivery of a structured teaching model, is an effective method of learning about appropriate wound management and, therefore, should be integrated into the undergraduate medical curriculum.

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Abstract
Background
Repositioning is widely recommended to prevent pressure injury (PI). Documentation of implemented pressure injury prevention (PIP) strategies is necessary for continuity of care. This pilot observational study aimed to describe the positioning patterns of patients at risk of developing PIs and to identify gaps in documentation of PIP strategies.
Methods
Patients were recruited from neurology and orthopaedic wards. Positions adopted were recorded during a two-hour observational period over three consecutive nursing shifts (day, evening, night). Demographic data, clinical details and recommended or implemented PIP strategies was obtained from medical records. Data were analysed descriptively using frequencies, percentages, medians, ranges and interquartile ranges as appropriate.
Results
Twenty-six out of 38 patients participated; the majority were orthopaedic patients with a median age of 66 years. Twenty-four had a PI risk assessment completed; 12 (50%) were scored at moderate to very high risk of PI. Four (33%) of those in the PI moderate to very high risk categories were prescribed a turning regime; 2 (17%) had received PIP education; and 6 (50%) had a pressure-relieving device recommended. The most observed positions for day shift were supine 46°–90° and sitting out; for afternoon shift were supine 46°–90° and supine 1°–45°, and for night shift left lateral or supine 1°–45°.
Conclusions
Acute care patients were most often observed in positions that place them at risk of PIs. Targeted PIP strategies are required that take into account patient movement patterns and address deficiencies in documentation of care.
Key points on what is already known on the topic
• Acute care patients are at high risk of PI.
• A suite of PIP strategies including repositioning are commonly recommended.
• Implementation of PI clinical guidelines is suboptimal.
• The positioning patterns of patients at risk of developing PIs has been little studied.
Manuscript contribution
• Acute care patients are most often observed adopting positions that place them at risk of PIs.
• Patients who can independently redistribute pressure should be educated to do so and taught to frequently change position.
• Targeted strategies for PIP are required to account for patient movement patterns and to address deficiencies in documentation of care.

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Question
What is the best available evidence in the effectiveness of topical silver to denature biofilm in wounds?

Abstract
Pressure ulcers are recognised universally as a largely preventable patient safety problem and a measure of the quality of care provided by health institutions. The prevalence of pressure ulcers among hospitalised patients in Nigeria has been sparingly reported. This study investigated the prevalence of Stages II to IV pressure ulcers among hospitalised adults in the six university hospitals in South-west Nigeria.
Participants were all hospitalised adult patients in the six university hospitals in South-west Nigeria. Data collected included age, gender, anatomical location of the pressure ulcer, and presence/absence of a relative by the patient’s bedside.
The mean age of patients with Stage II pressure ulcer and higher was 47.0±21.2 years. Prevalence of Stages II to IV pressure ulcers ranged between 0% and 6.9% in the hospitals and overall prevalence was 3.22%. Prevalence rates in male and female patients were 3.59% and 2.83% respectively. The most common anatomical locations for pressure ulcer were the ischial tuberosity, sacrum and greater trochanter. Most (92.3%) of the patients that had pressure ulcers also had relatives staying at their bedsides.
The prevalence of Stages I to IV pressure ulcers observed in this study was similar to rates reported from studies in which Stage I ulcers were similarly excluded while relatives’ presence by patients’ bedsides appeared not to have deterred the development of pressure ulcers.

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Abstract
The effects of living with a chronic wound and the potential loss of a limb is a serious occurrence that has a significant impact on a person’s quality of life and potential for healing1. This case study demonstrates the challenges associated with treating a person with a chronic arterial ulcer and why it is important for clinicians and patients alike to have the same goals of therapy in relation to the wound management. A combination of physical, social and environmental factors all have such a major impact on a person’s potential for healing including their quality of life and daily functioning. This case study clearly demonstrates the need for a holistic assessment of a person with a wound, not just wound care.

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