Final IIWCC online survey results

As part of the IIWCC I obtained ethics approval for a survey amongst the current and previous IIWCC students. Here are the final results attached. Please feel free to use.

http://www.scribd.com/share/upload/4710524/28w792k0x5yevzj1tfmn

Survey results

Coming soon!!!

I survived and passed IIWCC

Today I got my final mark back and I have passed everything. I survived IIWCC and passed. I got Masters Level in the majority of the module questions and also the selective. I met Kevin Woo last night. He suggests that I submit the paper to Wound Care Canada and also the poster to a forthcoming conference. Yeah.

Final selective submission

As part of the selective I have created a number of papers as initially outlined in the selective proposal. They include papers describing: a draft manuscript, simple enabler, enabler development process, enabler feedback, back-up educational resources.

http://www.scribd.com/doc/4360307/Enabler-development-process-Selective-John-Gregory?secret_password=21rrkdelmse75hm7mr0x
http://www.scribd.com/doc/4360299/Drafted-enabler-feedback-summary-John-Gregory-Selective-2008?secret_password=1qq4yml4wym8bwcuo4iq
http://www.scribd.com/doc/4360284/Draft-paper-ABI-Selective-John-Gregory-July-2008?secret_password=2jkb1k9cj2fsy6bgnvi9
http://www.scribd.com/doc/4360270/Back-up-educational-tool-Selective-John-Gregory?secret_password=f9j043917gew3km9o0v
http://www.scribd.com/doc/4360269/Simple-Enabler-Selective-John-Gregory?secret_password=nm8ldt516z8qz0mdnfq

Demystifying ABI with the use of a blog poster

I attach an abstract and PDF of a drafted posted entitled "Demystifying Ankle Brachial Pressure Index with the use of a blog".
This has been submitted today July 31st as part of the selective and it is hoped can be presented at a future wound care conference.
The poster summarizes the whole selective process, the use of ABI and the use of this blog as an enabler to practice. It also includes some feedback, future development and references.
Abstract
http://www.scribd.com/doc/4360943/Abstract-for-poster-on-ABI-selective-John-Gregory?secret_password=1rtmszvc2k53jw4dh2jp
Poster
http://www.scribd.com/doc/4361016/Demystifying-ABI-selective-poster-draft-John-Gregory?secret_password=230mamvj1j4usutznj95

Poster on conducting ABIs

Here is a poster and insert authored by the Kath & Peter Vowden. It is reproduced here with kind permission of the authors, Huntleigh Healthcare and British Journal of Community Nursing. The copyright of the Mark Allen Group is acknowledged. It summarizes very effectively the correct procedure for conducting ABIs and is a good accompaniment to the videos posted below on this blog.

http://www.scribd.com/share/upload/1743960/1ehv8eqiyxlxx19lrgbr

Videos of ABI procedure

The embedded videos demonstrate the Best Practice for conducting ABIs. They can be downloaded from this blog. I hope that this enabler will facilitate knowledge transfer and benefit clinical practice.

Waveforms

The use of a Multi Dopplex allows waveforms to be viewed on a computer or printed. The attached videos demonstrate triphasic, biphasic or monophasic arterial pulses. The waveform is more accurate than the ABI. The ABI can be affected by calcification of the arteries which is more evident in patients with diabetes who may have a falsely elevated ABI.

Questionnaire now online

After some requests I have created an online version of the survey on Survey Monkey. Here is the link.

Click Here to take survey

Health Professional Survey

Ethics has approved the use of the attached questionnaire as part of my selective. Great news. it has been a learning process to go through the process and gain the approval. Thank you to John and Diana for your help. It has been emailed to all current IIWCC students and should be going to all former students too. I hope that you can all help me by completing and returning by July 18th. the timing is tight as it took two and a half months to gain the ethics approval. They asked me to remove the request for personal demographic information. I will then only have a very short time to write up to submit my selective on July 31st.

New Zealand Guidelines Group

A clinician from Northern Ontario very kindly recommended the New Zealand Guidelines Group to me, with a link to the 'Care of people with Chronic Leg Ulcers - An evidence based guideline. December 1999. Thank you Mark. He had found my response on the CAWC Discussion Forum and taken the time to email me and the other clinicians is the discussion forum on ABI. I am reviewing the guidelines this weekend. I have also discovered that these guidelines are also referenced by the RNAO Best Practice Guidelines. The link to the guidelines is below:
http://www.nzgg.org.nz/guidelines/0008/Guideline_Summary.pdf

WoundPedia - Evidence Informed Practice

This is a wonderful new wound care resource launched at the World Union of Wound Healing Societies June 2008 in Toronto. It is available free at www.woundpedia.com

It contains sections on leg ulcers and other wound types. Within the section of leg ulcer diagnosis and assessment I was able to find the following systematic review.

Caruana MF, Bradbury AW, Adam DJ. The Validity, Reliability, Reproducibility and Extended Utility of Ankle to Brachial Pressure Index in Current Vascular Surgical Practice, European Journal of Vascular and Endovascular Surgery 2005;29:443-451. A systematic search was undertaken to locate articles addressing the validity, reliability, and utility of ankle to brachial pressure index for clinical and research use. This article provides a great deal of information about ABPI suggesting that it is useful in evaluating people with venous leg ulcers, atypical symptoms, and asymptomatic PAD.

Thanks WoundPedia. I recommend it!

Latest project plan

Here is my latest project plan. I am a little behind. I changed the plan to conduct a healthcare professional questionnaire rather than individual clinic visits. The questionnaire required ethics approval and this was step I had not made provision for. That said, preparing for ethics approval has been a learning experience in itself and I was able to gain feedback on a draft questionnaire at the World Congress.
http://www.scribd.com/doc/3499927/IIWCC-selective-plan?secret_password=213sk4qexkgehpfxcjq4

Does the patient's position alter their ABPI ratio?

I was very fortunate at the World Congress to meet a colleague and customer, Jacqui Fletcher. We had worked together many years before when I was at Smith & Nephew working on Wound Bed Preparation. Jacqui had done her Masters on ABI, with the title of her research above and she was kind enough to share her research with me. Jacqui is at the University of Hertfordshire, School of Nursing and Midwifery. Her email is j.fletcher@herts.ac.uk. It would not be appropriate for me to include her research here. Her work discusses the increasing use of doppler ultrasound as part of an holistic assessment to determine the arterial supply to the leg and that despite publications of guidelines that the technique remains poor. The study clearly identified differences in ABI recorded with the subject sitting or supine which are both statistically and clinically significant.

World Union of Wound Healing Societies meeting

I was hoping to have been able to have ethics approval in time for the World Congress and thereby conduct the questionnaire amongst different groups at the conference, for instance those delegates attending the Venous Leg Ulcer stream. Unfortunately, I was unable to gain expedited review in time. So as not to loose the advantage of this congress I was able to ask personally known international wound care opinion leaders and faculty members for their feedback on the construction of my questionnaire and to seek guidance in terms of whether I was asking the right questions. So the opportunity was not lost. I hope I do soon gain ethics approval. I now hope to send the questionnaire to the current international group of IIWCC students and also to approach former students to ask them whether they will agree to participate.
The World Congress was attending by 3500 delegates from 70 countries.

Healthcare professional questionnaire

The nature of my selective has evolved significantly. It had been my plan to arrange visits to healthcare facilities to understand how ABI are conducted in real situations and to discuss with clinicians and educators the challenges of implementation of best practice. Given work, this is difficult to coordinate and arrange. Instead, I began to consider a questionnaire. It has taken two months of discussion to agree a questionnaire and also to complete the necessary paperwork to apply for ethics approval for the study. this has been a valuable learning exercise in itself. I have had enormous help, support and guidance from the IIWCC Faculty and also from many wound care educators and opinion leaders.

Creating practice enablers

A fundamental part of this selective is describing the process in the development of the selective and the output. To demystify ABIs I had planned to create an enabler to practice to assist clinicians in the implementation and interpreation of ABIs. The plan was to conduct a survey amongst healthcare professionals and to create an enabler to include multi-media. In fact, this blog has become that very enabler. I have requested ethics approvals to conduct a survey of healthcare professionals and compare the difference subsets. I would hope to publish the survey findings on this blog too. I have also reveiwed the literature on enabler development. I found this article by Sue Rosenthal in Wound Care Canada titled 'Three tips for Creating Effective Enablers.

It can be found at http://www.cawc.net/open/wcc/4-3/enablertips.html

Sue cites three key considerations
1) Consider your audience.
2) Use analogy to help explain concepts and assist retention.
3) Present information in more than one way.

I am reflecting on these tips relative to my blog. More to follow!

The History of Doppler

The Austrian, Christain Doppler lived 1803-1853. He was a Professor in Elementary Mathematics and Practical Geometry at the Institute of Physics at Vienna University. He first published what we now call the Doppler Principle in 1843 describing the frequency of a source to its velocity relative to an observer. His work continued with demonstrations of musicians on a moving train and he published again in 1846. It was not until a century later in 1957 that there is eveidence of the effect being considered in medicine. Satomura used it to study the heart structure and functioning in 1957-59. Franklin 1961 produced an ultrasonic flow meter based on the Doppler principle and by the late 1960s it had been used on patients with arterial and venous disease. Yao did much of the ongoing research and by 1989 had established normal and abnormal pressure index.

New resource from WorldWideWounds

I found a paper by Peter and Kath Vowden on WorldWideWounds from 2001. There are several written by the Vowdens on the subject. On WorldWideWounds this link is still the most relevant from a search. I have written to both MEP and Peter Vowden.

Here is the link to the paper. http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html

I have also posted some comments and links on the CAWC Discussion Forum.

Arterial and venous sounds

Many healthcare professionals struggle with differentiating between venous and arterial sounds. These audio files are useful enablers to teaching and education on ABIs. The CAWC are included them in their S2 seminar series.

"Sounds coming soon!"

Canadian Association of Wound Care Quick Reference Guide

The CAWC have given me kind permission to include their Quick Reference Guide (QRG) on my blog. They are attached here in English and French. Thank you CAWC. More information can be found at www.cawc.net. Relevant to this selective on ABI are their Best Practice Recommendation summaries on leg ulcers and diabetic foot ulcers.
English
http://www.scribd.com/doc/3036172/CAWC-QRG-2006-ENG?secret_password=1z03udosnnc2hvkur8q6
French
http://www.scribd.com/doc/3036187/ACSPGRR2006FRE?secret_password=1co2v62d63v5c75y10p9

Best Practice Recommendations review

Here is the latest. Colleagues and friends have continued to direct me to valuable literature. Thank you Susie Seaman and the group in Cardiff, UK. I have added further, I need to review the RNAO best practice guidelines. I will then combine every thing and rework a consensus based on the different recommendations.

http://www.scribd.com/doc/2933554/ABI-Best-Practice-Guidelines?secret_password=2ctbnkic0lred2x24e25

ABI calculator enabler

This simple enabler was created based on the new (2006), Canadian Association of Wound Care Best Practice recommendations on venous leg ulcers

http://www.scribd.com/doc/2933540/ABI-calculator-and-guide?secret_password=c0wvn6enhohoe68qkv2

Enabler

It has just occurred to me that this blog is the enabler that I have been searching for. It allows a discussion forum and international exchange of ideas. It can be a community of practice and aid in knowledge transfer. I can attach the simple tools, research summary, multimedia audio and video files to help others learn and teach how to do ABIs. My paper and Congress poster will be the development of the process and the appropriateness of using a blog as a medical education enabler.

Continuation of my ABI literature review

Here is the continuation of my literature review, which I have added to. There is some good stuff out there. ABI searches also pick up Acquired Brain Injury and other medical disorder abbreviations. Many references are cross referencing and the same authors are recurring. They often refer to best practice guidelines also which will help next week in my review. I have taken quotes from the literature and acknowledged the source. At a later stage I will write a summary of this literature search and best practice review.

http://www.scribd.com/doc/2753136/ABI-literature-review?secret_password=2jyoersmx7t37uqjpl24

Selective Needs and Goals

Here is my identified needs and goals for my selective. It shows the resources that the selective plans to produce. This is the presentation I gave at the second IIWCC weekend.

http://www.scribd.com/doc/2621348/Selective-Need-Goal?ga_first_uploads=1&ga_uploads=1&secret_password=ckznm69b1nz901922h2

Interprofessional contact

The IIWCC program brings together healthcare professionals, researchers and people from industry from a wide spectrum of disciplines with a passion about wound care. The program also brings together professionals from around the world. At the most recent weekend there were discussions led by groups who have been pioneering wound care in Iran and British Gayana. It highlights for us all the tremendous work to do in many parts of the world and the major healthcare benefits we enjoy in many Canadian, American and European countries. Today, I began reading a book Me to We by two young Canadian authors and role models called Craig and Mark Kielburger.

I look forward to hearing from other like minded professionals. I would like to learn of your experience in conducting ABIs and any challenges and obstacles in teaching others how to use this simple technique. This will help me truly understand constructing enablers and multimedia tools to make healthcare professionals more confident is using this essential assessment tool.

Purpose of my blog

I am part way through a course at the University of Toronto called the International Interprofessional Wound Care Course, IIWCC for short. I am not a healthcare professional although I have been working in healthcare since 1992. As part of my program I am writing a selective. The title of the selective is 'to demystify ABIs by developing an enabler with support materials for future development and publication.

An ABI is a Ankle Brachial pressure Index (or ABPI), which is a measure of vascular supply to the legs.

The purpose of the selective is to demonstrate the process in the development of the project and I have decided to use this blog to catalogue the development process and also to solicit feedback from other healthcare professionals involved in wound care. I welcome your comments. I plan to add to this blog each week and I would like to post questions, surveys and votes. Finally I plan to attach embedded video and audio links which will help healthcare professionals to conduct ABIs on their patients.

I live in Ontario, Canada.