David Russell1, Leanne Atkin2, April Betts3, Caroline Dowsett4, Francis Fatoye5, Sarah Gardner6, Julie Green7, Chris Manu8, Tracey McKenzie9, Helena Meally10, Louise Mitchell11, Julie Mullings12, Isaac Odeyemi13, Andrew Sharpe14, Gillian Yeowell15, Nancy Devlin16. 1. Consultant Vascular Surgeon and Honorary Clinical Associate Professor, Leeds Teaching Hospitals NHS Trust. 2. Vascular Nurse Specialist, Mid Yorkshire Hospitals NHS Trust. 3. Health Technology Assessment Project Manager, Manchester Metropolitan University. 4. Nurse Consultant Tissue Viability, East London NHS Foundation Trust, London. 5. Professor of Health Economics and Outcomes, Manchester Metropolitan University. 6. Clinical Lead, Tissue Viability, Oxford Health NHS Foundation Trust. 7. Senior Lecturer in Nursing, Director of Postgraduate Programmes, Keele University, School of Nursing and Midwifery. 8. Consultant Diabetologist and Clinical Researcher in Diabetic Foot, King's College Hospital, London. 9. Head of Tissue Viability Services, Torbay and Southern Devon NHS Foundation Trust. 10. Hospital Podiatrist, Leeds Teaching Hospitals NHS Trust. 11. Clinical Lead Podiatrist, Birmingham Community HealthCare. 12. Lead Tissue Viability Nurse, University Hospital of South Manchester, NHS Foundation Trust. 13. Visiting Professor of Health Technology Assessment and Health Policy, Manchester Metropolitan University. 14. Advanced Podiatrist and Lecturer Practitioner, West Lancashire Community Service, Virgin Care and University of Huddersfield. 15. MSc Advanced Physiotherapy Programme Leader, Manchester Metropolitan University. 16. Director of Research, Professor, Office of Health Economics, Victoria Street, London.
Abstract
OBJECTIVE: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD: A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS: In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION: This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
OBJECTIVE: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. METHOD: A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. RESULTS: In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. CONCLUSION: This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
Entities:
Keywords:
Delphi; consensus; diabetic foot ulcers; dressings; venous leg ulcers; wound care
Authors: Gertrude van den Brink; Martha A C van Gaalen; Lissy de Ridder; C Janneke van der Woude; Johanna C Escher Journal: J Crohns Colitis Date: 2019-09-19 Impact factor: 9.071