From the Editor: Seizing the Opportunity for Innovation
This article was inspired by the thoughts of Keith Harding, CBE, FRCGP, FRCP, FLSW, Dean of Clinical Innovation, Head of Wound Healing Research Unit, School of Medicine, Cardiff University, Cardiff, UK.
As if to underscore the conundrum regarding innovation in wound care, 2 articles by Harding generated by the Proceedings of the 4th International Surgical Wound Forum cite “dramatic improvements in wound care”1 although “innovation in wound care has been slow.”2
Much of the contradiction centers on the fact wounds become chronic because of underlying patient comorbidities that interfere with healing; thus, general advancements in medicine may further the wound healing process as much or more as the most innovative topical treatment modalities. Diabetes needs to be managed, blood flow enhanced, and infections treated, among many pathogenic obstacles, before healing can commence or restart.
Also thwarting the push for innovation is the quality of the studies conducted on emerging products. According to Harding,2 many Cochrane reviews find evidence insufficient to guide practice, a big no-no in a recently extremely evidence-based health care world. Of course, that hasn’t stopped the proliferation of research on all means of advanced (translation: expensive) negative pressure devices, dressing materials, and light-providing, warm-up and cool down-inducing, electrical, and ultrasound therapies.
Further confounding the research issue are the often contradictory results: Harding2 cites a review3 in which 1 study clearly demonstrated a higher likelihood of healing using specific types of dressings, but 5 other studies showed no differences among compared dressings.
Alternative thought that might discourage innovation in healing is the prioritization of care — that is, to place symptom management to improve quality of life over need for complete wound closure. Along such lines, the Wound Healing Research Unit, developed in 1972 to offer a multidisciplinary, comprehensive approach to chronic wound healing, created the Cardiff Wound Impact Schedule to help clinicians identify patient concerns to subsequently negotiate individual care options. Is individualization a form of palliation — even surrender — in a patient reluctant to acquiesce to care protocols? Or would more patients be able to better cope if their wounds just didn’t hurt, smell, or ooze? Our goal of care may not be the patient’s goal of care.
Based on global patient demographics (including the prevalence of obesity, diabetes, and cardiovascular/vascular disease) and cost, not to mention the exasperating reality of living with and treating a chronic wound, the need for innovation in wound care remains crucial. Comorbidities, assessment and diagnostics, dressings and devices, and psychological factors continue to provide opportunities through which to innovate, especially if the focus shifts (and it is shifting, given the uptick in pharmacogenetics) to individualized approaches to care where tweaking care according to specific patient factors leads to healing. Innovation may come from looking back as well as forward: honey and silver are re-emerging as important protocol components, and I personally can attest to the healing and scar-diminishing qualities of aloe. The mind-body connection and the value of a reliable, caring support system (professional caregivers such as wound ostomy continence nurses and nonprofessionals such as family and friends) can never be over-explored or over-emphasized.
Because (like snowflakes) no 2 are alike, wounds continually challenge and inspire development of better ways to assess (is the Braden scale still the best instrument to predict risk for pressure ulcers), diagnose (what biological markers indicate wound deterioration or healing), treat (is gauze the villain or if used with certain dressings or negative pressure is it still beneficial), and prevent (is turning every 2 hours or a certain mattress or overlay the key) a chronic wound. There are guidelines to care, but none of them ensures healing. That requires the innovation of the folks at the bedside — from the physician or nurse who treats and tries and tries and treats a years’-long, incorrigible wound to the husband who blows the air from his oxygen tank on his wife’s ulcer to induce healing (it worked!), along with product and device manufacturers. In many case studies, good outcomes have been obtained using everything but the kitchen sink (and someone may have achieved success that way as well). Our Clinical Editor claims to have used egg whites and hair dryers; they worked, too.
When you lose your keys, they are always in the last place you looked. If you lose them again, the tendency might be to look first in that last place. My money is on the fact they probably weren’t in the same spot twice in a row. Innovation in wound care is like that: knowing what was once successful but realizing you might need to continue to search for those elusive keys.
This article was not subject to the Ostomy Wound Management peer-review process.
References
1. Harding K. Prologue: transformational healing solutions. J Wound Care. 2015;24(4 suppl):4–5.
2. Harding K. Innovation and wound healing. J Wound Care. 2015;24(4 suppl):7–13.
3. Dumville JC, Soares MO, O’Meara S, Cullum N. Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers. Diabetologia. 2012;55(7):1902–1910.
