Resources

Research shows that there could be over 175,000 people in the UK with the genetic condition Lynch syndrome (National Institute for Health and Care [NICE], 2016). As healthcare professionals, it is vital to follow the evidence to determine who may be affected by Lynch syndrome in order that they can have appropriate screening to decrease their risk of bowel cancer and other related cancers. Those leads are largely found in two ways. First, through testing those with bowel cancer to see if they have Lynch syndrome so that their relatives can be tested to see if they have also inherited the condition, this is done in secondary care. The second way is through identifying individuals with what are termed ‘high risk’ family histories so that they can be tested for Lynch syndrome. This can be achieved in primary or secondary care.

Wound management places a major demand on healthcare resources, which will continue to escalate with the increasing age and associated diseases of patients. But, that is no reason for inconsistent treatment, or treatment where the concerns and priorities of patients are not being addressed.

Of course, prevention and education need to be a priority, along with evidence-based wound treatments and research into developing existing pathways. However, patients also have rights and expectations that need to be considered. In our view, it is here where we have fallen down and where we continue to do so.

Sickle cell disease (SCD) is a debilitating, lifelong condition which places significant
societal and economic burden on patients, caregivers and healthcare systems; the realities of living with SCD for both patients and caregivers significantly impact quality of life,
and include mental health issues, as well affecting ability to attend and be successful at school or work, therefore reducing earning potential (Sickle Cell Health Awareness,
Perspectives and Experiences (SHAPE) survey, 2022).

This article, the first in a series on pressure ulcer prevention and management, looks
at undertaking risk assessment as the first step in preventing pressure damage. It
discusses the most popular tools in clinical practice, as well as how reliable they are in
predicting patient risk. Legal aspects of pressure ulcer risk assessment documentation
are also explored, together with future developments in producing a risk assessment
tool which can be used across all clinical settings in primary and secondary care.

When patients present with red lower legs, the cause is often assumed to be cellulitis or erysipelas. There are, however, several alternative conditions which mimic the clinical signs of cellulitis or erysipelas, which can lead to misdiagnosis. It is important that the
cause is correctly diagnosed to prevent inappropriate prescribing of antibiotics. This article discusses the different potential causes of ‘red legs’, in addition to cellulitis and erysipelas, together with clinical signs and symptoms to enable community nurses to differentiate
between them and implement appropriate treatments. Systemic antibiotics may not be the most appropriate management, and with the current focus on reducing antibiotic usage, community nurses need to be confident that they are prescribing them appropriately
and safely, and only when required.

The aim of this retrospective, real-world cohort analysis was to explore the clinical and financial benefits following the implementation of integrated care bundles (ICBs) within a real-world cohort of multiple wound types across two large community care facilities in Ontario, Canada. An observational, retrospective cohort analysis of the effectiveness and safety of a series of wound-specific ICBs, adopted to improve the management of open chronic wounds, was undertaken. Outcomes from patients who received a multilayered,
silicone adhesive foam dressing as part of their ICB were compared with outcomes from patients who did not receive the ICB. Patients who received the ICBs, including treatment with the foam dressing (n=16,841), experienced improved outcomes compared with those who did not receive the ICB (n=2242), including a faster time to healing (12.8 vs 25.5 weeks, respectively), and longer time between dressing changes (3.5 vs 1.9 days, respectively). Decreased mean nursing visits in the ICB cohort led directly to reduced resource costs, compared with mean per patient costs in the non-ICB cohort (CAD$1733 vs $6488, respectively). It was found that the reality of delivering evidence-based best practice that is optimally placed to deliver good outcomes can be challenging. However, the authors’ experience suggests that the adoption of pathways and ICBs may
make it easier to adopt best practice.

When most people, professionals or media discuss the NHS, it is more often NHS England that they think about. However, due to devolution, each country has its own form of NHS system. While the goal of any NHS system is to provide an excellent service for health
provision to their population, how it is delivered can vary greatly. This article examines how the initial NHS was set up, how devolution in Wales has changed how services in Wales are commissioned, and how this has impacted on continence/bladder/bowel care in Wales.

This article, the second in a three-part series on Long Covid (LC), focuses on how one community-based NHS LC clinic developed and now delivers a 10-week group-based virtual rehabilitation programme (VRP), which aims to provide persons with Long Covid (PwLC) concepts on current thinking in LC, alongside self-management education and support. It highlights the role of embedded clinical research fellows (CRF), and their role in an in-depth service evaluation of the VRP, using established research methods and being peer reviewed/supervised by a research team to support best practice in an evidence poor field.

It is estimated that there are currently 944,000 older people living with dementia in the UK, and that 593,200 of those people are living with advanced symptoms. People living with advanced dementia have a significantly higher prevalence of pressure ulcers (PUs), compared to those living without dementia with similar comorbidities. The care and support required to prevent pressure ulcers in people living with dementia needs to be individualised, following a holistic and person-centred assessment of the person and their unique circumstances. An improved understanding of the increased risk and causal factors of developing pressure ulcers in high risk groups, such as people living with advanced dementia, can support practitioners to conduct a more through and person-centred risk assessment and management plan, including choosing the most appropriate products to meet a person’s needs.

Use of the revised National Early Warning Score (NEWS) 2, a tool
used to measure acute deterioration in hospital, is mandatory in acute
NHS hospitals and ambulance services. Community staff who wish
to escalate acutely unwell people to ambulance or acute services need
to be able to use NEWS. This article outlines the uses and limitations
of NEWS and how it can aid identification and escalation of people
who are acutely unwell in community settings, including those with
suspected sepsis.