Primary care Resources

Aim: To evaluate whether switching to a multilayered, bordered, silicone-coated foam dressing (SFD) alongside structured clinical training reduces dressing changes and costs while maintaining or improving wound management in primary and home care settings. Method: Outpatients with hard-to-heal wounds that had been managed with foam dressings (other than the study dressing) were recruited. Data on foam dressing use in the seven days prior to the baseline assessment was recorded. Clinicians received structured training on SFD use and wear time. Eligible patients’ wounds were then dressed with SFDs for up to four weeks alongside standard care. Patient comfort, satisfaction and pain were recorded and clinicians evaluated dressing performance. Results: Thirty-seven patients completed the evaluation. The median number of SFDs changed within the seven days before the final visit was significantly less than that for previously used dressings (1 vs 3; p<0.001), equating to a 44% cost reduction. Despite poor prior healing, an average reduction in wound size of 68.7% from baseline to final visit was observed, with 32.4% of wounds fully healed. Clinicians rated SFDs highly across all assessed attributes. Patients reported less pain and better comfort. No dressing-related adverse events were reported.
Conclusion: Using SFDs with clinician training reduced dressing frequency and costs while improving wound outcomes and satisfaction of both patients and clinicians. However, due to the small sample size, short follow-up, and lack of a randomised comparator, further investigation using robust methods is needed.

Diagnosis of low back pain can be intriguing and complex. Careful history-taking and physical examination are essential to ensure red flags (serious issues) are not missed, that treatment is appropriate, evidence-based and timely, and that follow-up and review are well documented and understood by the patient. This article covers some of the more common causes of back pain in primary and urgent care.

A leg ulcer can be defined as a break in a person’s skin which becomes chronic in nature and takes longer than two weeks to heal (NHS UK, 2019). Evidence outlined by The National Institute for Health and Care Excellence (NICE) states that the prevalence of leg ulcers in the United Kingdom is around one percent over a lifetime, which still describes a large number of people (NICE 2022; Lim et al, 2018). The prevalence of leg ulcers continues to rise and a shift in lifestyle factors, including smoking and obesity, have contributed to this (Agale, 2013). Further risk factors for developing leg ulcers include immobility, advancing age, a history of varicose veins or deep vein thrombosis (DVT) and having a sedentary lifestyle (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Lim et al, 2018). The challenge of caring for these chronic wounds often falls to staff in primary care. Therefore, they should have a good understanding of leg ulcers and how best to treat them. In the author’s opinion, Leg Clubs® provide an ideal opportunity to manage lower limb wounds, while also tackling the wider holistic issues of leg ulcers, such as social isolation and loneliness.

Have you ever asked yourself why you wanted to be a community nurse in the first place? Perhaps you were interested in health promotion, or children’s services. Maybe it was the lack of shift work and an improved work–life balance, or simply the variety of patients in the
community. Whatever your reasons, it seems that less and less of your colleagues feel the same way, with community nurse attrition rates on the rise, and the numbers of retirees not being replaced by new registrants.

Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, loss of cognitive and social functioning brought about by progressive neurological disorders. There are estimated to be 850,000 people living with dementia in the UK and estimates indicate that this will increase to one million people by 2025 and two million by 2051. Left undiagnosed, dementia can have an insidious and devastating impact on the outcomes for patients and their families. However, we know more about its causes and some of the factors that may increase a person’s risk of developing the condition. This paper is the first in a series relating to dementia that will follow two families through their progression with dementia and considers the recognition and initial cognitive tests that can be used in a primary care setting. Each of the papers in the series will build upon our understanding of both families, as they face different issues and scenarios over the life course of the dementia.

The number of people living with complex, multiple health conditions is increasing. It is estimated that almost three million people in the UK have three or more long-term conditions, whether these are physical or mental, psychological or cognitive (King’s Fund, 2020). In addition, people living in more socially deprived areas are at greater risk of developing such conditions. Nurses working in the community have a hugely important role to play in supporting people affected to live the healthiest lives possible — working with carers and families.

This article reports on the monitoring of healing rates of fullthickness pressure ulcers at one care provider in the Midlands. This was an agreed measure that was part of the Commissioning for Quality and Innovation (CQUIN) incentive scheme for the CCG. It was an attempt to provide data to support the anecdotal reports that pressure ulcer healing rates had improved after the implementation of a pressure ulcer reduction scheme called the Midlands and East Pressure Ulcer Ambition in 2012. The healing times for full-thickness pressure ulcers were recorded at 40 and 80 days after being reported by the community care provider (a community interest company [CIC], providing NHS funded services). There were 138 patients included in the data collected over a one-year period in 2015. A total of 34% of the patients were healed or healing at 40 days. A total of 55% of patients were healed or healing at 80 days. Of the 138 patients who had a full-thickness pressure ulcer, 56 died (41%), 15% had deteriorating or static wounds at 40 days and 9% at 80 days. This demonstrates that the majority of full-thickness pressure ulcers progress to healing unless the patient is at the end of life. There should be a continued emphasis on preventing as many pressure ulcers as possible to reduce avoidable harm to patients.

This two-part series will discuss common lower limb problems, including venous leg ulceration, oedema (including oedema associated with lymphovenous disease), lymphoedema and lipoedema. This article will focus on the causes of these conditions and discusses the signs and symptoms to enable community nurses to diagnose and differentiate between the types of lower limb problems. Part two of the series will focus on management strategies for simple, uncomplicated venous leg ulceration and oedema, which can be successfully managed with skin care and compression therapy, without specialist skills. It will also briefly outline the management of lymphorrhoea or ‘leaking legs’, which can be challenging for nurses. The aim of this series is to enable community nurses to choose the most effective treatment in terms of efficacy and patient acceptability.

Primary care has been thrust centre stage recently with services moving closer to home. Jason Beckford-Ball speaks to Kathryn Evans of NHS England about what the future holds for community nurses...