No / It is now recognised that psychosocial factors – anxiety and depression, social isolation, low economic status and pain, for example – are associated with delayed healing of wounds. However, little research has been undertaken to examine how these factors may not only be a consequence of delayed healing, but may also play an important role in delaying healing. It is suggested that an evaluation of a patient’s psychosocial status should therefore be included as part of a general wound assessment.

No / Knowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types.

No / Knowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types.

Non-healing wounds is a growing medical problem, often associated with pathological conditions such as diabetes and peripheral ischemia. A non-healing wound entails a large amount of suffering for the patient, and demands extensive health care resources. In this thesis, a new drug treatment paradigm for wound healing was developed by transforming Limosilactobacillus reuteri R2LC with a plasmid encoding CXCL12 (LB_CXCL12). The drug candidate was tested for safety and biological effects following topical administration to full thickness wounds in both mice and minipigs. In parallel, different techniques, including 2D and 3D measurements, planimetry, and ultrasound, for assessing wound healing were developed and evaluated.   Murine wounds treated with LB_CXCL12 demonstrated increased proliferation of dermal cells, and an increased density of macrophages of which a larger fraction expressed TGF-β. If macrophages were depleted prior to wounding, the accelerated effect on healing was abolished demonstrating a macrophage-dependent mechanism of action. Importantly, the LB_CXCL12 treatment also accelerated wound healing in mice with impaired healing as a result of hyperglycemia or peripheral ischemia, conditions that in humans are associated with development of non-healing wounds. Wounds in minipigs treated with the freeze-dried formulation of LB_CXCL12, upon resuscitation referred to as ILP100, showed accelerated healing both by increased granulation tissue formation and accelerated re-epithelialization. The treatment with ILP100 was well tolerated with no treatment-related deviations in haematology, urinalysis, and histopathology. Further, we found improved detection of thin layers if newly formed epithelial using planimetry and ultrasound compared to 2D photographs, whereas 3D scans accounting for surface curvatures yielded larger wound areas than 2D photographs of the same wounds.  Development of topical treatments for non-healing wounds are limited by the proteolytic environment of the wound that cause degradation of applied molecules. Our developed technology, a new-in-class candidate, overcomes this by continuous on-site delivery and increased bioavailability of CXCL12, resulting in prolonged instruction of local immune cells to stimulate wound healing.

This study attempted to investigate the impact of new technology, specifically tele-advice on community nurses' care of leg ulcers. Firstly, a stratified randomised controlled study was designed to measure the impact of using this technology on their levels of wound knowledge and confidence. An individual self-test questionnaire and an attitudinal scale measured nurses' knowledge and confidence respectively both pre and post-intervention. Secondly, a new visual wound assessment tool was designed to represent the state of the wound by a single numerical value; the State of the Wound Index (SWI). Thirdly, the impact of nurses' knowledge, confidence and patient variables was explored to assess their impact on the state of the wound as represented by SWI. The sample consisted of thirty-eight registered primary care nurses from two local NHS trusts in South Wales and their corresponding 38 patients with venous leg ulcers. Nurses were stratified according to their qualifications into experimental or control groups. Both groups were shown to have comparable levels of knowledge and confidence pre-intervention. Nurses in the experimental group received expert tele-advice by a Clinical Nurse Specialist (CNS) over a 12 week period regarding the care of their patient's leg ulcer, whilst those in the control group continued to care for their leg ulcer patients in the traditional way. hi the experimental group, nurses' level of knowledge increased significantly (p=0.02) whilst no improvement was observed for the control group. In terms of confidence, the experimental group reached near significance when extremely positive statements were excluded with no improvement observed for the control group. Results show that the intervention had a positively significant impact on nurses' wound care knowledge and level of confidence. A set of 18 tele-transmittable wound factors was identified by a panel of wound experts. These factors were ranked by another independent panel of leg ulcer experts and no significance could be established in their order of importance. These factors were then examined for their highest and lowest possible estimates for every wound in the sample both pre and post intervention using a Visual Analogue Scale (VAS). These estimated values formed the basis for 95% confidence interval estimates from which 100 virtual nurse assessed values were generated. These values were then used to generate SWI. This new index ranged from 0 (best possible state) to 100 (worse possible) and was seen to reliably increase when the wound deteriorated and decrease as the wound improved. Linear regression models were built to establish the relationship between SWI, patient variables and nurses' knowledge and confidence levels pre and post-intervention. These indicated that knowledge and confidence can have a positive impact on the healing process. This study has shown that there is great potential for the use of tele-advice in community nurses' care of leg ulcers. For this to succeed, it is recommended that further pre and post registration nurse training is provided to enhance their knowledge in wound care, especially in the areas of physiology and wound assessment.

No description available.