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EWMA Conference 2007: finding a consensus

Una Adderley
DN RGN MSc BSc BA
Community Tissue Viability Prescribing Nurse
Scarborough, Whitby and Ryedale PCT

This year's European Wound Management Association (EWMA) conference took place in Glasgow. Its stated aims were to bring together clinicians from across Europe to focus on wound care research, develop consensus views with regard to care and develop new ways of driving forward the wound care agenda.
The conference opened by directly addressing this issue. Andrea Nelson challenged the audience to seek out high-quality evidence upon which to base practice. Keith Cutting then explored the complex issue of achieving consensus in wound care practice. He suggested that without robust research evidence, it is difficult to achieve wide-ranging agreement about what constitutes optimum care and implement best practice guidelines.

Topical negative pressure
Despite these difficulties, there is clear evidence of consensus in a variety of tissue viability clinical areas. EWMA has a history of developing high-quality position documents and consensus statements to guide clinicians' clinical practice. This conference launched the latest addition to the EWMA stable of position documents on the role of topical negative pressure (TNP, also known as VAC) in wound management. The document explains the pathophysiology of TNP, explores the health economics relating to TNP, and suggests when and how TNP might be applied in practice.
With regard to the use of TNP in the community, Sylvie Hampton presented the results of a survey which suggested that at present, few community patients have access to TNP. It appears that the lack of dedicated funding, education and competence prevent TNP provision.

Wound exudate and the role of dressings
Alongside the EWMA position paper, Peter Vowden introduced Wound Exudate and the Role of Dressings - A Consensus Document, which was recently published by the World Union of Wound Healing Societies' Initiative. He emphasised that exudate should not be viewed as a simple inert fluid but as a product of complicated physiological interaction. Wound exudate, when correctly managed, assists healing, but when poorly managed may be detrimental.
In addition to the plenary session, over 400 abstracts were accepted for oral presentations and posters. As usual, they addressed the management of diabetic foot ulcers, leg ulcers, wound infection, wound pain, pressure ulcers and lymphoedema. While all these areas are likely to be relevant to community nurses, some presentations had particular resonance.
Jo Dumville presented the results of a systematic review into the effectiveness of silver-based dressings and topical agents in the treatment of leg ulcers. This review found no robust evidence to direct clinicians' decision-making with regard to using silver dressings. This was said to be very surprising given the significant market share for these types of dressings.

Caring for patients with leg ulcers
Irene Anderson reported the results of a qualitative study that explored what impact caring for patients with leg ulcers has on nurses. The study identified six key themes and concluded that nurses' pragmatism, empathy and persistence are essential in building therapeutic relationships. Effective teamwork also appeared important for ensuring that nurses avoid fatigue that might adversely affect their patient care. 
Christine Lindholm spoke about a study that investigated pain experienced before, during and after dressing changes with the aim of illuminating dressing change-related pain. The study found that cleansing was the most painful part of the dressing change procedure, but warm water or analgesics could reduce this level of pain if administered before the dressing was changed. In discussion, it was reported that the discovery of unacceptably high levels of pain led to the creation of a structured approach to pain relief in the research site.
Niamh McLain presented a quantitative Irish study that examined whether community patients with leg ulceration are assessed according to best practice. The study found that a significant proportion of patients were not optimally assessed. The use of a formal assessment tool seemed to be associated with an improved level of assessment.

Maggot therapy
Maggot therapy has been enjoying a resurgence in popularity as a debridement method for treating leg ulceration. It is often assumed that any reluctance to using this method will come from patients. But Karen Spilsbury reported that most patients with leg ulcers in a study exploring attitudes towards larval therapy did not object to this method of treatment.
Phil Morgan presented an update on the Lymphoedema Framework Project which began in 2001 with the aim of identifying the extent of lymphoedema in a defined population. This has led to the identification of lymphoedema as a significant but unrecognised problem, which has subsequently led to lymphoedema being placed on the healthcare agenda. Although lymphoedema is still poorly understood and managed overall, there is evidence that community nurses are starting to recognise the need to improve their assessment and management skills in this field.
Alongside the scientific presentations, there was an extensive exhibition of wound care products and satellite symposia presenting new products. Unfortunately, marketing often seems to precede the science and nurses caring for patients with wounds still lack the evidence needed in order to implement evidence-based practice. Case studies cannot replace robust randomised controlled trials when evaluating the effectiveness of a wound care product. Hopefully, Andrea Nelson's call for high-quality evidence will be heard.

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