Diagnosis in Wound Healing Raj Mani
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1Step by Step: Diagnosis in Wound Healing2
3Step by Step: Diagnosis in Wound Healing
Raj Mani PhD FACA FIPEM CCSi DTech Director, Vascular Laboratory Southampton University Hospitals Trust NHS, Mailpoint 29, Level D, Centre Block, Southampton General Hospital Tremona Road, Southampton SO 16 6YD
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Step by Step Diagnosis in Wound Healing
© 2007, Raj Mani
All rights reserved. No part of this publication and Photo CD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2007
9788180618604
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Contributors
Denise Privett BSc (Hons) RGN trained in Southampton (1973) and practiced elderly care nursing for 4 years before she moved to District Nursing in Gosport. It was while working as a District Nurse that Denise specialised in wound care, gained her Honours degree in Community Nursing. After working for a short while on the attractive island of Guernsey, Denise gained experience of working in wound care industry before starting her current position. Denise is a Clinical Nurse Specialist — Leg Ulcers Southampton City PCT where she has a team of 3 specialist nurses of different grades.
Denise is interested in research and teaching and works closely with the Wound Healing Group led by Raj Mani and Cliff Shearman in Southampton University Hospital.
Caroline Smith BSc (Hons) RGN
Caroline Smith qualified as a nurse in 1974, and went on to work in Surgery, high care and Elderly care until the urge for a change of direction occurred in the mid 1980's. Day care in the local hospitals was beginning to expand, so she joined the Radiology department at the Royal Victoria Hospital, Boscombe in 1988. 6This fine but old building was closed and demolished in the early 1990's, forcing a not unwelcome relocation to a much larger department in the brand-new Royal Bournemouth Hospital. She continued to learn the finer points of Radiology and Cardiology nursing for several years.
In 1996, she decided to indulge her right brain, and was awarded a degree in Visual Arts in the year 2000. The debate concerning whether to define Nursing as an art or a science continues.
Caroline now runs the Radiology Day Care Unit for Southampton University Hospitals Trust, and is involved in research in Vascular Radiology. She is studying to become a Nurse Prescriber in order to improve the treatment of patients in Radiology, and is a musician in her spare time.
Sue Bale FRCN, PhD, BA, RGN, NDN, RHV, PG Dip, Dip N
Sue Bale has a career wound healing research that spans 24 years. During this time she has produced a large body of work comprising 111 publications in peer-reviewed journals; 18 books and chapters; 81 international conference papers, and a selection of 32 posters presented at international conferences. Sue is a founder member of the Wound Care Society (1985); the European Wound Management Association; (1991); the Journal of Wound Care (1992); the European Pressure Ulcer Advisory Panel (1996). 7She is currently a council member of the EWMA and a Trustee of the EPUAP.
In 2004 Sue received recognition for her services to wound healing when the Royal College of Nursing conferred on her a Fellowship for her outstanding contribution to nursing research, development and practice of wound care in the UK and internationally.
Her current post is Associate Director of Nursing (R&D) in Gwent Healthcare NHS Trust. Responsibilities of this post include engendering a research culture within the organisation, encouraging participation in research activities, and co-ordinating and overseeing research in the Trust.
Sue research interests continue in wound healing and she is recently participated in an international, multi-centre phenomenological study of the lived experience of patients with pressure ulcers. Patient empowerment and involvement in research are other research interests. Contact: email: sue.bale@gwent.ac.uk
Graham Bowen—Chief II Podiatrist: Clinical Lead for Diabetes Southampton City Primary Care Trust.
I qualified as a Podiatrist in 1988 and since then have fostered a keen interest in the foot in Diabetes, both from a clinical and education aspect. I have been involved in the Diabetes care within the NHS, Canada and Education since 1988.8
After working in the NSH for a couple of years, I moved to develop a Podiatry service in Canada in 1990. Here I found that there was a complete absence of any type of foot care or foot education for patients with diabetes. In the three years I was there, I worked within a multi-professional team and became involved in foot health promotion and professional development and training for health professional colleagues.
I joined Southampton City PCT as Lead Podiatrist for Diabetes in March 2004 with a view to improve the Diabetes Foot Service in both the Primary and Secondary Care. Already these improvements have shown a reduction in inpatient length of stay, improved outcomes and increased access for Podiatry for patients with Diabetes in primary care.
As Podiatry clinical lead for Diabetes, I am responsible for the provision of Diabetes Foot care across Southampton City, New Forest and Eastleigh and Test Valley South PCTs and Southampton University Hospital Trusts.
I am keen to continually improve the profile of Podiatry and Diabetes within the local health community. I am very keen to support professionals working in Diabetes. I am devising a strategy for all professional staff to be updated on current treatments of the Foot in Diabetes, on antibiotic therapy and the use of digital photography to aid the management of diabetic foot ulceration.
I am of the opinion that it is essential to nurture the next generation of Podiatry and Health Care professionals dealing with the Foot in Diabetes and so am looking to develop a ‘one stop’ Diabetes placement. 9This will enable future professionals to see acute Foot and Diabetes problems, such as ulceration, and to observe how the diabetes multi-professional team works to resolve and treat these problems.
Raj Mani PhD, FACA, FIPEM, C Csi, D Tech
Raj Mani is a Consultant in Clinical Sciences and a Senior Lecturer in Southampton University Hospitals Trust where he has worked since November 1979. Raj is trained and accredited in Medical Biophysics and Angiology. After developing a vascular laboratory, Raj applied its techniques to wound healing research. A number of post graduate students have worked in this laboratory to gain higher degrees.
Raj Mani developed an interest in tissue hypoxia in chronic wounds and has worked in the microcirculation and wounds since early 1980's. He has published a series of original papers and delivered lectures in Europe, USA, Africa and India. Raj is a Founder and Editor of the Cochrane Wounds Group, an Editor of Angiology and the Editor-in-Chief of International Journal of Lower Extremity Wounds. For his contributions to introducing measurements in wound healing, Raj was awarded a higher doctorate from the University of Glamorgan in 2004.101112
13Introduction
There has been almost a frantic level of activity in the world of wound healing over the last 25 years or so. To check this statement, just search the literature in the top indexed databases prior to 1980s. It is highly likely that some mention of varicose veins, diabetic foot complications and a passing reference to pressure ulcers is all that a diligent search will yield. By comparison, a search of Medline/Embase/Index Medicus today will yield literature on wound management, wound diagnosis, basic research in wound healing and even on wound audit. Again, while papers on lower extremity wounds could be presented or heard at meetings on the skin or veins as sectional events, today there are a number of large professional societies with annual meetings in Europe, USA, Australia and India. There are others too. So why this increased activity and where is it all leading to?
I have been fortunate to be involved in wound healing over this period to which I refer above. During this period, we have seen some remarkable research findings, some incredibly helpful advances in technology, the concept of evidence-based medicine and the establishment of the International Cochrane Wounds Group the outputs of which feed the National Institute of Clinical Effectiveness (NICE) but few admissions that satisfactory chronic wound care obtains everywhere that it is needed. Why? My 14pragmatic nature suggests that education and training are lacking in this area of endeavour. It is to address this angle that we in the World Union of Wound Healing Societies (WUWHS) decided to produce a series of educational handbooks. This handbook “Step by Step Diagnosis in Wound Healing” is the second in this series.
The aim of this handbook is to inform the reader of the local procedure that is based on evidence and has been validated formally or through audits. If any or every statement made is in conflict with the successful experience of a reader, please do get in touch with us. While our ways have and continue to work well, we welcome every opportunity to improve our standards. The book will be posted on the website of the World Union of Wound Healing Societies, as will comments. The reader therefore needs to distil the information contained, weigh it against local methods/experience before deciding on the need for any changes.
With the exception of Sue Bale (who is from Gwent, S Wales) all the colleagues work in Southampton University Hospitals Trust. Its been a good experience working with these guys over this manuscript.
Raj Mani
Chair of the Publications
Commission World Union of Wound Healing Societies (WUWHS)
31 January 2006