Resources

The total estimated cost of managing wounds in the UK is reported to be more than £5 billion per year, with a great deal of that cost coming from nursing time (Guest et al, 2015). Patients with lower leg wounds should receive an ankle brachial pressure index (ABPI) before compression therapy (Wounds UK, 2019). Measuring ABPI using the traditional Doppler probe, however, can be unreliable, time-consuming and can only be carried out by practitioners with specialist training and knowledge (Al-Qaisi et al, 2009). Waiting times for appointments can also delay treatment. Automated ABPI assessments are speedy, accurate and do not require specialist nurses, thus freeing up nursing time and lowering costs, as well as reducing waiting and assessment times (Boast et al, 2019). This article assesses the introduction of the MESI ABPI (medi UK) automated device at a Leg Club in North East Essex. The challenges faced by the Leg Club are discussed, along with the benefits seen over a two-month period after acquiring the automated ABPI device.

Hard-to-heal wounds are challenging to manage and incur a cost burden to healthcare systems through extended treatment periods, resource use and patient quality of life. The aim of the service evaluation presented here was to determine the wound healing and health economic impact of using PICO™ Single Use Negative Pressure Wound Therapy (sNPWT) on hard-to-heal wounds at seven centres across Northern Ireland and the Republic of Ireland. Patients with clinically defined hard-to-heal wounds received PICO sNPWT, as per a clinician-endorsed PICO sNPWT hard-to-heal pathway (Dowsett et al, 2017). Wounds were assessed for their healing trajectory over a 12-week period. Of wounds included (n=36), 20 (55.6%) healed within the 12-week routine follow-up period. Wounds of <3 months’ duration reported a significantly higher healing rate compared to wounds with a duration of >3 months (p=0.0125). Dressing-change frequency significantly reduced during PICO sNPWT treatment compared to the standard dressing regime before the evaluation (p<0.001). Furthermore, dressing change frequency remained significantly reduced after PICO sNPWT treatment was introduced, when compared to the pre-pathway standard dressing regimen (p<0.001). Health economic modelling suggested a cost-saving of 21% (€12,001) for the Republic of Ireland, and 25% (£15,467) in Northern Ireland, by using the PICO sNPWT hard-toheal pathway compared to standard wound management.

Active diabetic foot disease relates to problems associated with peripheral arterial disease (PAD), infection and/or neuropathy. Diabetes still remains one of the main causes of non-traumatic limb amputation and premature death, both of which may be preventable (Prompers et al, 2007; National Institute for Health and Care Excellence [NICE], 2019). The purpose of this article is to discuss three of the clinical emergencies seen in the diabetic foot, namely PAD, infection and Charcot neuro-osteoarthropathy (Charcot foot). The aim is to provide a refresher of diabetes and the associated complications and to enhance knowledge and clinical skills in the management of diabetic foot disease. A case report is used to provide narrative to the potential complexity seen within the process.

Non-cystic fibrosis (CF) (bronchiectasis) is a common chronic lung condition, which occurs due to damage to the airways leading to persistent cough, sputum production and recurrent chest infections (Hill et al, 2018). This article focuses on the adult patient and describes the pathophysiology, aetiology, investigation, and management of bronchiectasis in the primary care setting. The aim is to raise awareness of this disease, which is increasing in prevalence and to empower community nurses with information to support patients through the bronchiectasis disease trajectory.

Hydration is an essential component of life. Fluid balance monitoring in health and social care has been a routine monitoring tool carried out by nursing staff for many decades. The evidence suggests poor compliance and inaccurate data with lack of time or appropriate staff cited as the reasons for this. Several recent high profile cases have attributed fatalities to a lack of adequate hydration of patients in health/social care environments. Managing someone’s input and output can have a signifcant effect on their health and wellbeing. Accurate monitoring can also assist diagnosis and ultimately guide appropriate treatment choices for people with lower urinary tract symptoms. This article looks at the variety in terminology and practice, discusses the importance of maintaining accurate monitoring, and the essential components of a useful monitoing tool. It also identifies some of the challenges faced in maintaining effective monitoring of fluid balance with suggestions for improving practice.

The development of an integrated children’s bladder and bowel service is a key recommendation from a number of national documents and helps ensure affected children are seen at the right time and place and by the right person. This facilitates potential cost savings in the long term, with resultant reductions in A&E attendance and secondary care referrals. The key reference document is the Children’s Continence Commissioning Guide, which sets out a clear service framework. By working with several services across the UK, a generic service model has been developed which supports appropriate interventions at both tier 1 and tier 2, including the development of care pathways to help reduce unwarranted variation and inequalities in the provision of care. The key to success with this model is also the empowerment of families to help them self-manage the child’s problem, which also fits within the NHS Long Term Plan (NHS England, 2019).

Here, Nihara Krause, consultant clinical psychologist and founder and chief executive officer of stem4, gives an overview of the resources available for children and young people with mental health needs, and recommends changes that are drastically needed to meet demand and improve services. She also explores work currently being done by stem4 to help identify and support children and young people, and discusses early digital interventions which can help with treatment.