Resources

The problem of delayed wound healing has been highlighted in several publications which has stimulated debate on variance and the need for updated care pathways. This paper demonstrates how adjunctive therapy can be added to the ‘standard care’ model, described in the National Wound Care Strategy Programme’s recommendations for lower limb wounds, to enhance outcomes for patients with ‘hard-to-heal’ lower limb wounds (NWCSP, 2020). A decision-making pathway based on published literature is described,  which uses wound assessment and observed response to treatment to allow the effective and targeted introduction of adjunctive therapies for ‘hard-to-heal’ wounds. This approach will allow the cost-effective introduction of new and evolving therapies, such as WoundExpress™(Huntleigh Healthcare), which addresses the underlying problems associated with resistant lower limb oedema and compromised venous function. The pathway also indicates how other adjunctive or innovative topical wound-based treatments can be integrated to optimise outcomes while providing cost-effective care.

This article explores why we should adapt assessment of leg ulceration to be more mindful of the presence of lymphoedema. If clinicians can change the assessment process and begin to treat leg ucleration with a lymphatic component differently to venous oedema, this, in turn, can potentially reduce complications such as toe, foot and knee oedema. The introduction of simple changes in documentation and additional training can lead to improved outcomes for patients as well as potential cost savings for healthcare providers.  

When a person experiences symptoms that are suspected to be a possible dementia, they may be referred for specialist memory assessment. However, in the initial diagnostic stages, delirium and depression are differential diagnoses that require consideration, with attention paid to ruling these out as they can mimic the presentation of dementia. Similarly, delirium and depression can be superimposed on a person who already has an existing diagnosis of dementia. In both instances, this can be distressing and debilitating  and requires community nurses to be able to differentiate between the conditions and to take appropriate measures to enable rapid identification and assessment and, when required, onward referral for treatment and management. The differentiating signs and symptoms of the three conditions can vary in their subtlety and similarity and require vigilance to identify in a timely manner. Community nurses have a significant role to play in the screening, identification, assessment and management of patients with dementia, delirium and depression. This paper is the fifth in a series that follows two patient stories in their experiences of dementia.

Bladder and bowel difficulties affect 20% and 10% of the UK population, respectively (Percival et al, 2021). This is most likely not an accurate reflection of the true scale of this often under-reported health issue. Pelvic floor dysfunction can cause symptoms relating to many different systems and its management involves numerous modalities. The management of bladder, bowel and pelvic floor dysfunction should be delivered in the community via general practitioners, pelvic health physiotherapists and bladder and bowel services. An effective multidisciplinary approach using pathways to reduce secondary care involvement unless required should be adopted. Post Covid, community bladder and bowel services are recovering from prolonged redeployment, a backlog of cancelled patients and a rising waiting list. Acute services are the same, with even bigger backlogs for benign lower urinary tract dysfunction and prolapse assessment. Scrutiny of current bladder and bowel services across new clinical commissioning group (CCG) collaborations will undoubtedly uncover the disparity in quality of service provision. 

Here, the authors, who all work at Leeds Community Healthcare NHS Trust (see below), look at the definition, data and principles of recognising and supporting victims of domestic abuse among service users. They also explore how staff in their trust are equipped not only to address issues of domestic abuse and violence with patients, but also to support employees who themselves are going through these experiences.