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.