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The European Wound Management Association

Una Adderley
RGN DN BSc BA
Research Nurse
Centre for Evidence Based Nursing
Department of Health Studies
University of York
District Nurse Scarborough and NE Yorks NHS Trust
E:una@adderleyspringfarm.fsnet.co.uk

The European Wound Management Association (EWMA) was founded in 1991 at a conference in Cardiff to address clinical and scientific issues associated with wound healing represented by medical, nursing, scientific and pharmaceutical interests. Every year the Association holds a conference on aspects of wound management throughout Europe. This year's took place in Granada, Spain. Nursing in Practice sent Una Adderley along to report on proceedings.

The Conference
Following the opening address, the first session looked at the wider issues of quality of life for patients with chronic wounds. Patricia Price, from the Wound Healing Research Unit in Cardiff, noted "the paucity of research" on the impact of chronic wounds that do not heal. Peter Franks, from the Centre for Research and Implementation of Clinical Practice at Thames Valley University, highlighted the evidence relating to the impact of leg ulceration on patients' psychological status and health-related quality of life, and suggested that psychosocial factors may play an important role in both the development of chronic leg ulceration and the potential for ulcer healing. Deborah Hofman, from the Wound Healing Institute in Oxford, focused on pain management in wound care. Her address drew attention to the increasing interest in the problem of pain management associated with chronic wounds.
The conference attracted over 2,000 delegates and speakers from a wide range of countries. The presentations focused on a huge variety of subjects relating to wound care, with the majority of presentations being simultaneously translated into a variety of European languages. There was considerable sympathy for the hardworking translation teams, who not only had to cope with the usual challenging photos that accompany any wound care presentation but also the swift and enthusiastic delivery of many of the speakers. A sympathy vote went out to the translator who ended up translating for a particularly animated lecturer who spoke for well over an hour!
 
Pain and wound care
The assessment and management of pain related to wound care was given particular emphasis. In recent years, both wound care practice and research have paid more and more attention to quality-of-life assessment, and pain has been identified as a major issue. In response, EWMA has undertaken a multinational survey of health professionals involved in wound care, which discovered both similarities and differences in practice. The results have prompted the publication of EWMA's recent position document - Pain at wound dressing changes. In the introduction, Christine Moffatt, from the Centre for Research and Implementation of Clinical Practice at Thames Valley University, notes that: "The current understanding of wound pain is primarily drawn from the literature relating to other conditions and on the physiology of acute and chronic pain. The lack of clear understanding of pain in patients with wounds, prompted a review of the theory of pain," which has been included in the position document. Christine Moffatt concluded her introduction by acknowledging that, "The last decade has focused on healing; the next decade must focus on the patient, with pain management a priority." This document is available on request from ewma@congress-consult.com
Michelle Briggs, from the University of Leeds, presented a thought-provoking session on managing pain at wound dressing changes. She outlined areas for consideration for pain assessment, emphasising the need for a broad holistic approach to management that should include good preparation, appropriate dressing choice and adequate analgesia.  Her talk outlined the dimensions of pain and discussed the issue of hypersensitivity when a patient experiences an increased response due to repeated unrelieved pain.
 
Other topics
In addition to the main plenary sessions, there were rich pickings to be found within the vast selection of oral presentations, workshops, satellite symposia and poster presentations. The main difficulty was in ­choosing from such a wide range of subjects and speakers. The workshop on debridement chaired by Finn Gottrup, from the Copenhagen Wound Healing Centre, and Deborah Hofman, enabled a fascinating discussion and comparison of both the possible benefits of debridement and the different methods used by participants from around Europe. Clinicians from across Europe shared clinical experiences and discussed subjects ranging from the ethics of debridement to the practicalities of getting ­larvae therapy to stay in place.
The subject of palliative care and chronic wounds was addressed both in plenary sessions and workshops. Patricia Grocott, from King's College, London, focused on the challenge of caring for patients with neoplastic wounds, with a particular emphasis on the assessment of the periwound skin. The workshop provided an opportunity for European practitioners to share ideas and experiences regarding a clinical area where, at present, very little research evidence exists to guide practice. Caring for neoplasic wounds can be very challenging; the treatment of the disease can often cause similar symptoms as the disease itself. Proposals included the early use of barrier products to minimise maceration, the use of latex moulded systems to contain absorbent dressings and minimise leakage, and the use of haemostatic surgical sponges to stop bleeding in the case of haemorrhage.
In addition to the clinically focused sessions, the scientists also presented on the latest advances in tissue engineering. George Cherry, from the Oxford Wound Healing Institute, reported on the progress being made regarding the use of stem cells in tissue repair as direct transplants, to construct bioartificial tissue for implantation and to stimulate resident stem cells to regenerate tissue at the site of injury. Researchers currently believe that cultured cells may possibly enter the medical marketplace within the next five years.
Finn Gottrup highlighted the increasing use of skin transplantation in chronic ulcers and presented results of a study that suggested that this treatment is promising but further investigations are needed to identify more exactly the possible indications and benefits. Marco Romanelli, from the University of Pisa, discussed the progress in tissue engineering, where bioengineered skin substitutes are looking promising as an alternative treatment for vascular and diabetic foot ulcers.
The workshops and oral presentations also addressed issues that impact on clinical care. Andrea Nelson, from the University of York, and Jose Verdu, from the Universidad de Alicante, presented on practice based on evidence and chronic wounds; Moya Morison, from the University of Abertay, spoke on problem-based learning; and Nigel Chapman, from the Coroner's Office in Nottinghamshire, reinforced the need for high-quality documentation.
The huge trade exhibition gave a welcome opportunity for clinicians to mix with industry. One of the more patronising arguments levied against the introduction of nurse prescribing in the UK was that nurses might be vulnerable to the pressures of unscrupulous industry and should therefore avoid contact for fear of contamination! In Granada, clinicians from all backgrounds were able to meet with industry to hear about new products, discuss the advantages and limitations of known ­products, and make suggestions.
The conference concluded with an overview of chronic wound care policies from across Europe. Although the presenters from seven different European countries outlined very different arrangements for patient care and clinician education, the EWMA umbrella offers the opportunity for countries to become involved in a number of initiatives that seek to improve wound care across Europe and present a united voice for wound care at international level.

Grants and bursaries are available to enable members of EWMA to ­undertake study or travel connected with woundcare. If you would like to find about more about EWMA the website address is W:www.ewma.org
Next year's EWMA ­conference will take place in Pisa, Italy