This document sets out to understand the prevalence of various health and chronic illness risk factors among those with chronic wounds and how those factors influence healing.
Part 1 provides background information on population health and identifies the risk factors for chronic illnesses that are the focus of this document. Factors including stress, sleep, smoking, medication, illicit drug use and alcohol consumption are explored, all commencing with an understanding of pathophysiology as it relates to wound healing, followed by a review of the literature as it applies to chronic wounds. Evidence of interventions at the level of randomised controlled trials (RCTs) to manage these factors and their impact on wound prevention or treatment is limited and thus we will refer to systematic reviews, observational studies and in vitro studies as appropriate.
Archives
The Impact of Patient Health and Lifestyle Factors on Wound Healing, Part 2 Physical Activity and Nutrition
Part two of the EWMA document ‘The impact of patient health and lifestyle factors on wound healing’ focuses on two factors: physical activity and nutrition. In this paper, the pathophysiological understanding of how physical activity and nutrition either increase the risk for wounding or impact the healing process will be presented. We review current evidence for the effectiveness of interventions in improving healing outcomes and offer some recommendations for practice and further research. This part of the document should be read in conjunction with Part 11, which discussed stress, sleep, smoking, illicit drug use and alcohol misuse and described how some commonly used medications impact the healing process.
Australian Guideline on Wound Healing Interventions to Enhance Healing of Foot Ulcers Part of the 2021 Australian Evidence-Based Guidelines for Diabetes Related Foot Disease
Abstract
Background: Diabetes-related foot ulceration (DFU) has a substantial burden on both individuals and healthcare systems both globally and in Australia. There is a pressing need for updated guidelines on wound healing interventions to improve outcomes for people living with DFU. A national expert panel was convened to develop new Australian evidence-based guidelines on wound healing interventions for people with DFU by adapting suitable international guidelines to the Australian context.
Methods: The panel followed National Health and Medical Research Council (NHMRC) procedures to adapt suitable international guidelines by the International Working Group of the Diabetic Foot (IWGDF) to the Australian context. The panel systematically screened, assessed and judged all IWGDF wound healing recommendations using ADAPTE and GRADE frameworks for adapting guidelines to decide which recommendations should be adopted, adapted or
excluded in the Australian context. Each recommendation had their wording, quality of evidence, and strength of recommendation re-evaluated, plus rationale, justifications and implementation considerations provided for the Australian context. This guideline underwent public consultation, further revision and approval by ten national peak bodies.
UK NICE 2023 MTG42 UrgoStart for treating diabetic foot ulcers and leg ulcers
Evidence-based recommendations on UrgoStart for treating diabetic foot ulcers and leg ulcers.
In April 2023, NICE updated section 1 to reflect the current format of NICE guidance. NICE also added some text to the clinical evidence section to summarise new clinical evidence reviewed. NICE’s recommendations for UrgoStart remain unchanged. More details are in the review decision. New text is marked [2023].
NICE medical technologies guidance addresses specific technologies notified to NICE by sponsors. The ‘case for adoption’ is based on the claimed advantages of introducing the specific technology compared with current management of the condition. This case is reviewed against the evidence submitted and expert advice. If the case for adopting the technology is supported, then the technology has been found to offer advantages to patients and the NHS. The specific recommendations on individual technologies are not intended to limit use of other relevant technologies which may offer similar advantages.
This guidance replaces NICE medtech innovation briefing on UrgoStart for chronic wounds (MIB82).
Practical Guidelines on the Prevention and Management of Diabetes-Related Foot Disease IWGDF 2023 Update
Diabetes-related foot disease results in a major global burden for patients and the healthcare system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence-based guidelines on the prevention and management of diabetes-related foot disease since 1999. In 2023, all IWGDF Guidelines have been updated, based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In addition, a new guideline on acute Charcot neuro-osteoarthropathy was created. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification and management of diabetes-related foot disease, based on the seven IWGDF Guidelines. We also describe the organizational levels to successfully prevent and treat diabetes-related foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of healthcare professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes-related lower-extremity amputations. The burden of foot disease and amputations is increasing at a rapid rate, and comparatively more so in middle to lower income countries. These guidelines also assist in defining standards of prevention and care in the these countries. In conclusion, we hope that these updated practical guidelines continue to serve as a reference document to aid healthcare providers in reducing the global burden of diabetes-related foot disease.
