A STIMULATING AND SUCCESSFUL CONFERENCE FOR THE EPUAP IN BERLIN
Reproduced from the Journal of Wound Care, Vol. 15, No .9, October 2006, p. 411

With over 500 delegates and more than 35 speakers, this conference provided ample opportunity for networking and to hear about developments in pressure ulcer care.

Delegates from Europe, the US (boosted by a delegation from the National Pressure Ulcer Advisory Board Panel, [NPUAP]), Australia, Japan, Korea and China met together last month in Berlin at the ninth European Pressure Ulcer Advisory Panel (EPUAP) open meeting.

The conference theme was ‘pressure ulcers: putting knowledge into practice’, and included a host of stimulating presentations with topics such as technological advances in pressure ulcer prevention, microbiology, the patient’s experience of living with a leg ulcer, tissue reflectance spectroscopy and the development of test methods for support surfaces.

Given the large number of presentations it would be impossible to describe them all here, but I would like to focus on a few that caught my eye.

Papers
Dan Bader highlighted the need for objective monitoring to identify at-risk individuals and the conditions, such as the patient-support interface, that can lead to tissue breakdown. New technologies being developed can image the entire soft-tissue composition down to the underlying bony prominences, evaluate damage at the cellular level and predict
the local mechanical environment within the tissue. Such techniques may have the potential to provide new monitoring systems for practitioners. Dr Bader reminded us that a better understanding of the physiology of pressure ulceration is the key to prevention and management.

Jane Nixon reported on the PRESSURE trial: a randomised controlled trial (RCT) that compared alternating pressure mattresses and overlays in 11 hospitals (including six NHS trusts). Its objective was to determine whether there are any differences between the two, with a primary end point of the development of a grade II or above pressure ulcer. The sample consisted of 1972 patients aged 55 or over admitted in the previous 24 hours to vascular, orthopaedic, medical or elderly acute care wards, either as acute or elective admissions. Of the sample, 990 were randomised to overlays and 982 to mattresses. Intention-to-treat analysis found no difference in the proportion of patients who developed new pressures ulcers in either group. However, the mattresses were associated with lower overall costs.

Jeannie Donnelly announced the results of a RCT comparing leg elevation with therapy mattresses in the prevention
of pressure ulcers on the heels of people with fractured hips. She set out to further investigate the theory that offloading is an effective measure in preventing heel pressure ulcers.

All patients with a hip fracture admitted to the Royal Hospitals Trust, Belfast, were recruited if they had a fractured hip, were aged 65 or over, and gave informed consent. Patients whose fractures had occurred 48 hours previously or had existing heel damage were excluded. Patients were randomised to receive one of two treatment options: heels elevated or heels down. The primary outcome was development of a grade I or above pressure ulcer. Assessments were verified by an experienced tissue viability nurse blinded to the intervention. Patients in the control group developed more pressure damage than those in the intervention group. The results were so pronounced that the study was stopped half way through on ethical grounds.

Other events
The EPUAP also announced the formation of the Shear Force Initiative Group, comprising the EPUAP, the NPUAP and the Japanese Pressure Ulcer Society. The group has two goals: to identify the clinical significance of shear force (and agree on a definition), and explore how best to monitor shear. The group first met in Aberdeen at last year’s EPUAP open meeting, and held a follow-up meeting in Berlin.

Industry were represented both in the exhibition, and by sponsored symposia, with KCI supporting a session on a holistic approach to pressure ulcer management, Nutricia a symposium on nutrition and healing, Smith & Nephew a session on adapting to the complexity in wound management, Gaymar one on deep tissue injury and Gerromed one on electrical stimulation in healing.

Next year will see the EPUAP celebrate its tenth anniversary open meeting in Oxford from 30 August to 1 September 2007.

Tracy Cowan
Deputy Editor/Production Editor, Journal of Wound Care