Abstract: Pressure ulcers are common in most healthcare settings, yet precise estimates of incidence and prevalence are unknown. In particular, very little is known about the occurrence of pressure ulcers in hospice care settings. This article reports on a study to describe incidence and prevalence in a sample of home hospice patients who were followed by pharmacists providing palliative pharmacotherapy care planning and consultation to hospice nurses in 4 hospice programs. The researcher examined retrospective data for patients admitted to hospice during the first 6 months of calendar year 2003 for each of the 4 hospice programs (Time 1); for hospice nurse-reported pressure ulcer prevalence at the inception of the prospective study (Time 2); and for the 3-month study period (Time 3). Ninety-nine patients developed pressure ulcers during the study period (incidence = 10%). Prevalence of pressure ulcers for Time 3 was 26.9%. Patients who developed pressure ulcers were significantly olde

Abstract: The prevalence of wounds, particularly pressure ulcers, has been collected over several years with little sustained improvements in overall rates. Consideration and appreciation of the complexity of the heterogeneous nature of the elderly population in the United States as well as the wounds themselves may offer some insight as to why prevalence rates seem so intractable. Frailty, as a descriptive term, has not achieved consensus among health professionals but nevertheless denotes a permanent loss in functional ability. It is common to find care of the frail elderly partitioned into treatments of discrete symptoms. This can often mean treatment goals are established without consideration of the burdensome impact of the treatments themselves for the frail elderly. These interventions, often fruitless, do not prioritize quality-of-life issues, limit independence, and result in further isolation of the frail elderly. Prevalence evaluations are a valuable tool in understanding an

Abstract: In chronic wound patients with advanced disease, endpoints other than closure offer improvements in quality of life. Odor management and exudate control are realistic wound care goals that have not received a great deal of attention. Sixteen cancer patients with malodorous wounds were treated with a compounded topical formulation consisting of metronidazole 0.75% in a gel vehicle. Treatments were performed daily or twice a day at dressing changes consisting of a nonadherent primary dressing and an absorbent (gauze or nonwoven) secondary dressing. Wound odor was evaluated both by the patient and investigator using a subjective assessment scale of 0–10 (0=no odor detectable, 5=moderate, noticeable but not offensive, 10=offensive, putrid). The amount of wound exudate and skin maceration was evaluated clinically. Safety evaluations included wound volume (to determine if the test agent deteriorated the wound) and monitoring of unexpected adverse events. Complete elimination of odo

Abstract: Wounds are commonly encountered at the end of life. There is a need for palliative wound care, but little exists, and public policies do not focus on palliation. Understanding the magnitude and scope of the problem can provide a basis for developing palliative treatments and influencing public policy. Method: A cross-sectional study and retrospective records review from patients in a large urban/suburban hospice were conducted to describe (a) the prevalence of wounds and (b) the types of wounds and characteristics of hospice patients referred for wound care. Among 383 hospice patients, 35% had skin wounds, of which 50% were pressure ulcers. In a case series of 192 consecutive patients referred for wound consultation, the average age of patients was 82, 67% of patients were female, patients had numerous co-morbidities, and 40% of all wounds were pressure ulcers. Despite short treatment periods, palliative wound care measures resulted in significant healing for nearly half of w

Abstract: There is a growing interest in applying the tenets of palliative care to patients with nonhealing wounds. Palliative care measures are appropriate for patients with nonhealing wounds at any point along the continuum of care. The decision, however, to move a patient from a curative treatment plan toward a plan of care that focuses on symptom modification and wound stabilization requires the clinician to know if the wound is truly recalcitrant or simply under-treated. This article examines wound healing outcomes in a newly created subacute wound unit and begins to define an evidence- and outcomes-based approach to establishing a palliative wound program integrated into a fully comprehensive wound healing program.

Abstract: Poster topics and study designs presented at the 2003 and 2004 Symposium on Advanced Wound Care were summarized and compared to gain insight into current wound care developments and trends. The percentage of product-related posters increased from 54% in 2003 to 76.5% in 2004. The greatest increase was observed in the so-called physical treatment modalities category (eg, vacuum-assisted closure, electrical stimulation). They represented 11% of poster topics in 2003 compared to more than 25% in 2004. The proportion of laboratory research studies presented decreased from 25% to 10% of posters while the percentage of clinical case studies increased from 40% to 50%. These observations may provide useful information to clinicians and manufacturers.