Some of our recent editorials have focused on the emerging changes in wound care, both positive and negative. As an orphan clinical subject we often find ourselves in the spotlight–or should we rephrase that as our patients often struggle to access capable clinicians and effective treatments.
Many of our readers have ploughed ‘heart and soul’ into the management of this very complex clinical situation, dealing first hand with the ‘life‐altering’ effects of living with a wound. While the subject may be in its orphan stages as a true clinical specialty, its costs and impact to society are certainly not–now being ranked alongside heart disease and cancer!
Yet the ‘poor cousins' we are! Often overlooked, mostly misunderstood and an easy target for the ill informed. As practitioners we see and benefit from the technological advances that have become available to us over the past three decades, finally lifting us from treating patients by poorly informed clinicians and using traditional products. Such advances have not only benefited us as care givers but have significantly changed the lives of our patients often saving limbs; relieving pain or managing chronic co‐ morbidities.
Many of us are no doubt alarmed by recent publications suggesting that there is no or little evidence to support the use of these more modern products (e.g. silver dressings and negative pressure therapy). Even more alarming however is how healthcare systems are using this limited evidence to control our access to these products.
No one denies that, when compared to pharmaceutical products or some implantable medical devices, the evidence available for wound care products is not the best! The management and treatment of wounds is a multi‐factorial, total patient management issue. We not only have to consider the wound itself but also the patient. Many underlying complex co‐morbidities can have a significant impact on the patients' health and their wound environment. As clinicians we sometimes need to deal with an aspect of the patient's health not associated with the wound but the treatment to address this issue may indeed have an impact on their wound with or without our knowledge.
Patient management is our first priority and wound management has to follow on from this. Bearing this in mind it is difficult to understand how a dressing is expected, in every circumstance, to provide a consistent effect on an ever changing wound environment.
So how to collect evidence using traditional approaches (e.g. RCT), is an ongoing challenge and burden for wound care practitioners. We understand the model, we understand the need but more importantly we understand the benefits that these treatments bring to our patients and how we need to stand up for ourselves and our patients when we are challenged by purists and theoretical researchers who always ask for more research to be done but with no practical advice of what should be recommended today.
Thirty years of clinical practice, knowledge, and improved understanding of many of these technologies with time and multiple applications (many millions in some cases) must surely count for something.
As governments are taking more interest in the problem of patients with wounds, we as the ‘experts’ on the ground have to stand up and be counted. We must make our collective voice heard to ensure that wound care continues to develop as a clinical specialty rather than being driven backwards–where we all understand that the costs both financial and social will be significant. Please use publications like IWJ and other wound related publications, your local politicians, civil servants, patient advocacy groups, professional associations or quite frankly anyone who will listen to ensure that patients obtain the best possible treatments for their wounds and for most of us as caregivers and/or tax payers best value for our investment.
Keith Harding and Douglas Queen