Cambridge Media Journals - Volume 23 Number 1 (2024)

Aim To face teaching challenges during COVID-19, a new three-step blended learning pedagogical scenario for leg ulcers was developed combining e-learning, theoretical seminars and workshops. The aim of this survey is to explore students’ perceptions of the three-step learning unit presented during the COVID-19 pandemic.

Method An online anonymous survey comprising five Likert scale questions and two open-ended questions was sent to the 151 participating nursing students. Quantitative data were analysed with descriptive statistics, and qualitative data were addressed using thematic analysis.

Results A total of 68 students participated in this survey. The students reported that the newly developed three-step unit promoted their learning. The allocated time for the e-learning was, for 20 (29%) students, insufficient. The qualitative data demonstrated the benefits of studying in small groups and using e-learning as well as following a structured learning program. Workshops led by clinical nurse specialists and the use of adapted wound care materials were reported as essential.

Conclusion Students appreciate this three-step blended-learning unit. Small groups led by clinical specialists promote a positive learning environment. Further research is needed to evaluate the effectiveness of this approach.

Authors’ contributions All authors were responsible and accountable for all parts of this project and participated in the data analyses. More specifically, PB started the development of this project. PB and CMT developed and designed the e-learning. LuC, CG and PB developed the workshops. LaCa and SP provided feedback and significant input on the project and workshops. PB and CMT analysed quantitative data, and PB, GG and SP analysed qualitative data. PB, SP and GG contributed to writing the manuscript; all authors revised the manuscript and gave their approval of the final version to be published.

Background Venous leg ulcers (VLU) are common wounds, mainly in the gaiter region of the leg. Compression therapy is an effective treatment for reducing the time to healing of VLU. The four-layer bandage and two-layer hosiery protocols are supported by good evidence for clinical and cost effectiveness. There is more limited evidence for other treatments, such as the two-layer bandage and compression wraps. Robust evidence is required to compare the clinical and cost effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of VLU whilst offering value for money.

Aim VenUS 6 aims to investigate the clinical and cost effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of VLU.

Method This multicentre, pragmatic, three-arm parallel group study aims to recruit 675 eligible participants aged ≥18 years with at least one VLU, and who can tolerate full compression and give written consent. Participants are allocated 1:1:1 to receive evidence-based compression, two-layer bandage or compression wrap. Participants are followed up with weekly assessments until the participant’s reference leg is ulcer-free and no further nursing assessments are required to treat the leg. Reference ulcer healing is confirmed by a healthcare professional/treating nurse. Participant-reported outcomes are collected at baseline and at 1, 3, 6 and 12 months. The primary outcome is time to healing of the reference ulcer. Secondary outcomes include clinical events and participant-reported ulcer related pain, quality of life, treatment adherence and resource use.

Background Pilonidal sinus disease affects many individuals in the UK and is associated with chronicity, pain and recurrence. It has a negative impact on the individual’s quality of life and daily functioning and places a significant burden on the UK’s healthcare service.

Traditionally, treatment has involved excision and healing by primary or secondary intention; however, recent advances in surgical techniques have led to the development of endoscopic and video assisted treatments.

Aim This paper evaluates the current research surrounding the endoscopic treatment of pilonidal sinus disease, with particular reference to patient benefits and harm.

Methods A Medline search of endoscopic/video-assisted and pilonidal sinus disease in adults was undertaken. There was minimal level 1 evidence, due to the recent nature of the treatment’s development, therefore levels 1–3 were reviewed.

Findings Patients generally experience less pain and a quicker return to normal functioning following endoscopic treatment; however, this approach does not appear to improve recurrence rates and may only be replicable in uncomplicated pilonidal disease.

Implications for clinical practice Endoscopic treatments appear to be an interesting new technique for the treatment of simple pilonidal disease; however, further work is required to identify a technique that also addresses recurrence rates.

Introduction Between 10 and 34% of healthcare expenditures are wasted. Given the expansion of the European advanced wound care market to $3.51 billion by 2025, healthcare systems will face problems unless they adopt models that help curb waste and prevent myopic spending. This manuscript introduces an outcome-based pricing model.

Methods For one year, a Swiss hospital prospectively examined and treated all venous and diabetic wounds meeting inclusion criteria with either standard of care or fish-skin graft. A model for expected time to wound closure was used to evaluate the conditions and assess how well surrogate endpoints predict wound outcomes.

Results Data show that surrogate endpoints are predictive enough to facilitate clinical decision-making regarding the use of intact fish skin grafts much earlier than the grafts used in usual models. While the intact fish skin graft products are initially more expensive than standard of care, they allow decision-makers to take hospital length of stay and other factors into account. Further, the difference in cost was quite substantial in favour of fish skin grafts over the long term. This model allows payors to mitigate risks when evaluating novel products, as healthcare systems do not pay for worse outcomes in new products. Even with this added cost, innovators benefit by reaping more data to use when refining products.

Conclusions Balancing innovation, care and cost with the system stresses to come will likely require a new means of understanding all three. This model provides a potential solution to one thorny juncture of these forces.