W NEWSFLASH nr°17 HOSPITHERA,

HOSPITHERA,
YOUR PARTNER IN DAYCARE
W
06/2014
OUNDCARE
NEWSFLASH nr°17
CONTENT: p1. INTRO
p4. CASE STUDY: POLYMEM
p6. PRODUCTNEWS: SANICAST
p2. IN THE PICTURE: EWMA 2014
p5. PRODUCTNEWS/ SCARBAN p7. CONTACT
Beste wondzorgspecialist,
De zomer staat voor de deur en velen onder jullie kijken ongetwijfeld al uit naar een
welverdiende vakantie. Wij hebben alvast wat lectuur voor u klaar om de zomermaanden
door te komen!
In deze 17e newsletter blikken terug naar het EWMA-congres in Madrid, de grootste
internationale bijeenkomst op gebied van wondzorg.
Als partner in de wondzorg biedt Hospithera u immers een aantal gevestigde waarden aan
binnen dit domein, die eveneens allen vertegenwoordigd waren op EWMA.
Eén van onze belangrijkste leveranciers, PolyMem, presenteerde er dit jaar twee posters over
het gebruik van dit product bij radiotherapie-geïnduceerde huidletsels. Lees de volledige
studies op pagina 4.
Verder stellen we u in deze newsletter ook nog twee nieuwe producten voor:
- Scarban: voor de preventie en behandeling van hypertrofische en keloïde littekens en voor
de behandeling van brandwonden.
- en Sanicast: voor het reinigen van de huid onder een gipsverband.
Veel leesplezier!
HOSPITHERA
Hospithera, opgericht in 1962, verdeelt medische hulpmiddelen ontwikkeld door betrouwbare
leveranciers met een internationale reputatie. Door de jaren heen is Hospithera uitgegroeid tot
de bevoorrechte partner van ziekenhuizen en gezondheidsprofessionals, dankzij een toegewijd
verkoopsteam en oplossingen op maat. U kan op ons rekenen!
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IN THE PICTURE: EWMA 2014
Onze partners op het EWMA-congres
De 24e editie van het congres van de European Wound Management Association vond dit jaar
plaats in Madrid, Spanje van 14 tot 16 mei.
Het was één van de meeste succesvolle edities tot nu toe, met meer dan 3400 deelnemers uit 80
verschillende landen en 1150 wetenschappelijke presentaties. Hospithera is dan ook trots om met
enkele van de bevoorrechte industriepartners van EWMA te kunnen samenwerken.
Een van onze belangrijkste partners, trouwens ook gold sponsor van de EWMA organisatie, is
PolyMem. PolyMem was heel zichtbaar aanwezig met een prominente stand, evenals een VIP-area,
waar verschillende lezingen en workshops georganiseerd werden. Deze workshops behandelden
vooral het gebruik van PolyMem verbanden bij radiotherapie-geïnduceerde huidletsels, de
introductie van Nursicare en het gebruik van de nieuwe PolyMem Surgical voor een snellere
wondheling en infectiepreventie bij postoperatieve wonden na knie- en heuparthroplastieën.
Hierbij alvast enkele sfeerfoto’s:
PolyMem verbanden
4 unieke eigenschappen
gecombineerd in één verband:
hydraterend, reinigend,
absorberend, vullend.
Finger / Toe Dressings
Optimaliseer de genezing!
Ideale keuze voor het behandelen
van hematomen, verstuikingen,
snijwonden, brandwonden,
ulcers, matricectomiën.
Nursicare
Steriel borstkompres voor
moeders die borstvoeding geven:
Verzacht en beschermt pijnlijke
tepels, versnelt de genezing van
tepelkloven, absorbeert lekken
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IN THE PICTURE: EWMA 2014
Onze partners op het EWMA-congres
Actisorb 220 Silver,
Adaptic, Algosteril,
Bioclusive, Inadine,
Nu-derm, Nu-Gel,
Promogran, Silvercel,
Tielle, Tielle Plus,
Tielle Xtra
Systagenix
Levert innovatieve producten voor
de behandeling van chronische
en chirurgische wonden en de
controle van bloedingen.
Aldanex
Preventie en behandeling van
vochtletsels.
Microdacyn
Geëlektrolyseerde pH-neutrale
vloeistof voor het reinigen,
uitspoelen en bevochtigen van
chronische wonden.
Revamil
Hydroactieve en
zuiverende honinggel
om het helingsproces te
optimaliseren.
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CASE STUDY: POLYMEM
Het gebruik van PolyMem bij radiotherapie-geïnduceerde huidletsels
In België krijgen meer dan 60000 mensen per jaar de diagnose van kanker. Meer dan de helft
van deze mensen krijgt hiervoor onder andere radiotherapiebehandeling. Deze behandeling
heeft een negatieve invloed op de huid en veroorzaakt dan ook in veel gevallen huidletsels.
PolyMem blijkt in veel gevallen een heel doeltreffende oplossing te vormen in de preventie en
behandeling van deze huidletsels; Tijdens EWMA 2014 werden hierover 2 posters voorgesteld,
vanuit de UK. PolyMem wordt volgens verschillende nationale oncologische guidelines in de
UK zelfs beschouwd als het te verkiezen verband bij radiotherapie-geïnduceerde huidletsels.
Klik op de poster om te vergroten.
Evaluation of a PolymEric mEmbranE DrEssing in thE
managEmEnt of raDiothEraPy inDucED skin rEactions in
hEaD anD nEck cancEr PatiEnts
Aim:
To evaluate if; Polymeric membrane dressing
was effective in the management of patients
presenting with radiotherapy induced skin
damage.
Method:
A bespoke evaluation captured information on
the patients’ age, gender, radiotherapy dosage,
nutritional status, cancer type and location, RTOG
rating, wound pain score and pain at dressing
change. Patients were provided with a free text
diary to log their pain using a numerical and
Wong and Baker Face scale. Pain medication
and sleep patterns. Each week, the RTOG rating,
wound size, location and description, pain score
of wound, pain associated with dressing change
and dressing wear time was completed by the
clinician, patients or carers. This continued for a
maximum of 4 weeks.
Results:
A total of 20 patients, 17 men and 3 women, with
a mean age of 56.8 all had a primary diagnosis of
head and neck cancer. 65% of patients had RTOG
scale of 2, 25% RTOG rating 2.5. A significant
finding in this study included the decline in
wound pain scores between week 1-3. By week 4,
15/20 of patients skin had healed. Patient diaries
provided valuable data with common themes
including:
• Increased sleeping hours
• Dramatic reduction in pain during wear time of
the dressing
• Increased healing rates when compared to the
standard treatment
• Patients and carers were able to change the
dressings
• Reduction in pain medication
P305
Lead Author: audrey scott
macmillan head and neck cns
mount vernon cancer centre
rickmansworth road, northwood
middlesex, ha6 2rn.
E-mail address: audreyscott2@nhs.net
The use of patient diaries gave a unique insight
into patients with skin damage. The use of
advanced wound dressing improved quality of
life in these vulnerable patients.
Lead Contact & Lead Author
Evaluation Leads - Fionnula Hegarty
Senior Sister
Bart’s Health NHS Trust, West Smithfield
London, EC1A 7BE
Tel: +44 (0)20 3416 5000
E.Mail: fionnula.hegarty@bartshealth.nhs.uk
Second Author
Evaluation Leads - Michele Wong
Senior Sister
Bart’s Health NHS Trust, West Smithfield
London, EC1A 7BE
Tel: +44 (0)20 3416 5000
E.Mail: michele.wong@bartshealth.nhs.uk
Fig 1. Mean patient Pain score using numerical scale 1- 10 over a period of two weeks.
Introduction
RTOG Grade
Management
Rationale
0 (no change to
skin)
Continue with own skin care regime and use of
patients own non perfumed, easily absorbed
moisturiser. Past practice has been aqueous cream
but evidence has shown this can be any non
perfumed, easily absorbed cream. Follow general
Skin care guidelines. Consider the use of a barrier
film if indicated to delay the onset of reactions.
Promote hydrated skin and maintain
integrity.
Assess Weekly.
1 (Faint/dull
erythema)
Continue with skin care regime and use of
moisturiser. Consider appropriate analgesia for
pain. Consider the use of anti-histamine to aid with
itching.
Promote hydrated skin and patient
comfort. Management of itch and
pain as required. Assess weekly in
clinic
2a (bright
erythema/dry
desquamation/
sore, itchy skin)
Increase application of creams as required. Consider
commencement of dressings, such as Hydrogels, gels and sheets, foams.
Promote hydrated skin and patient
comfort. Control pain from skin
reaction. Management of itch. Assess
weekly
2b (Patchy
moist
desquamation.
Yellow exudate/
pain)
Continue moisturiser on unbroken skin. Swab as
necessary to check for local infection – consider use
of systemic antibiotics if infection confirmed. Apply
appropriate dressing to treatment area (Hydrogels,
Polymem, foams) Dressing use will be decided by
the specialist team depending on the treatment
field. Continued use of systemic analgesia. Refer to
district nurse (DN) as necessary, especially if patient
unable to manage self changes.
To promote patient comfort. Reduce
further trauma and infection. Reduce
pain, soreness and discomfort for the
patient. Assess on a more frequent
basis. To be decided by the team.
3 (Confluent
Moist
desquamation,
oedema,
soreness)
Continue as RTOG 2b with use of dressings. Swab as
necessary to check for local infection. Ensure patient
self management with dressings, refer to DN as
necessary.
Continued patient comfort as much
as possible. Reduce the risk of added
complications.
4 (Ulceration,
bleeding,
necrosis)
Rarely seen. Management should be considered on
an individual basis and discussed with the Medical
team on all occasions.
Fig 1. Management of skin reactions and use of dressings taken from Mount Vernon Cancer Centre skin care guidelines for during and after radiotherapy
treatment. Audrey Scott, Macmillan Head and Neck CNS on behalf of Mount Vernon Cancer Centre Radiotherapy Skin Care Group. 2013 p9-10.
In England, over 275,000 people per year are diagnosed with cancer and more than half of these receive
radiotherapy1. Bart’s radiotherapy department sees approximately 1000 patients per year. A current skin
care protocol consists of hydrogels, covered with a non-adhesive dressing secured with bandages. Post
treatment, topical anti-inflammatory cream is applied. The Radiation Therapy Oncology Group (RTOG)
acute radiation morbidity scoring criteria is commonly used to classify skin reactions, which range from
0 - 42 Most patients with RTOG of 2 - 2.5 will progress onto RTOG 3. With a current average healing time
of 4 - 6 weeks3, a clinical evaluation of Polymeric dressing was undertaken to determine its efficacy and
potential to improve patient outcomes.
Methodology
Fig 2. Patient Recorded Sleep Patterns.
Full consent was obtained and any patient could withdraw. This study aims to evaluate if a polymeric
membrane dressing is effective for the management of patients presenting with a RTOG score of 1 - 2.5
over a four-week period. In particular, to assess it’s performance in: Improving skin integrity, managing
dry and moist desquamation, relieving pain and inflammation improving quality of life. An evaluation
form used provided information on the patient’s age, gender, dosage, nutritional status, cancer type and
location, RTOG rating, wound pain and dressing change. In addition, patients were given a free text daily
diary to record pain scores using the Wong and Baker Face scale, type and level of analgesia and sleep
patterns. The evaluation consisted of baseline details and continued for a maximum of 4 weeks.
Results
Fig 3. RTOG 2 Injury
A total of 74 evaluations were completed 23 patients with a mean age of 60. Cancer types, 8 head and
neck, breast cancer, 7 patients, anal cancer, 3 patients, vulva cancer, 3 patients and lower leg, 2 patients.
48% (11) patients had an RTOG grade 2.5 (moist desquamation with sloughy tissue), 48% (11) patients had
an RTOG grade of 2 (bright erythema/dry desquamation with sore, itchy and tight skin) and 4% (1) had an
RTOG grade of 3 (confluent moist desquamation).
Fig 1. Pain scores. As the study progressed, the documentation of pain scores reduced. It is impossible to
state if this was due to the dressing, analgesia or lack of documentation. It is evident the records for the
first 14 days were more accurate with an average score of 6.3 on day 1. The total number of patients at
week two totalling 18/23 had a mean pain score of 1.8.
Fig 2. Patient recorded Sleep patterns. Sleep is an important process that aids healing. Loss of sleep can
often be linked to pain and stress. It was felt that if the dressings were able to reduce inflammation and
pain then sleep patterns would improve. Fig 2. Shows the individual patient diary sleep patterns of 20/23
patients records. Week one, 6/23 patients were recording sleep patterns of none to 2-4 hours. By day 6, all
patients recorded sleep patterns 4-6 to 6-8 hours. It must be remembered that by day six, 8 patients had
stopped recording sleep patterns. By day 11, a total of 15 patients had stopped recording sleep patterns.
Fig 4. RTOG 1 Injury
Conclusion
This study into the treatment of radiotherapy induced skin reactions, improved wound management
in regards to pain, exudate control and patient comfort. Some of the anatomical areas treated created
challenges in securing the dressings and this study highlighted the need for training in this area. The
patient diaries gave the authors valuable insight in the management of patients with RTOG damage.
Fig 5. RTOG 2b Injury
Patient Pain Diaries
The Polymeric Membrane dressing in-situ
Patient 1
“Wore dressing all day. Found I went to lay down in afternoon and realized I sitting for a
little while something I have not been able to do for a long time.
Did not sleep v well but did not get any pain until 5pm Took 2 paracetamol at 6.15pm.”
Patient 2
“July 16th - going to see nurse today to get clean dressing nurse said looking good only a
little discomfort when I walk and sit down dressing definitely helps when you put a clean one
on pain definitely easier.”
Patient 6
“By keeping the dressing damp with saline solution relief was achieved when the infection was
at its worse the dressing needed to be changed twice a day.”
Patient 8
“No pain no soreness or itching relieved.”
Patient 9
“I have no problem endorsing the product given that it is essential a product that is truly
fit for purpose.”
Patient 15
“Soon as dressing applied pain eased.”
Patient Comments:
Fig 2. Pain, sleep and analgesic diaries kept by patients 1-4 weeks
Discussion:
Evaluation of Polymeric Membrane
Dressing for Radiotherapy Induced
Skin Reactions
Patient 11, day 3 “When the dressing is removed
within a short space of time the burn dries and
hurts like hell, when the dressing is applied the
relief is almost instant and the pain drops to 0”.
Fig 6. RTOG 2b Injury
Patient Mean Pain Score
10
8
Fig 7. H&N Patient
Patient 19, day 5 “I would highly recommend this
dressing, when wearing for more than one day,
used a small squirt of saline (2 mls) this cooled the
wound right down immediately- great tip”.
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Fig 3. Patient mean pain score over 14 days
References
1. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation TherapyOncology Group (RTOG) and the European Organisation for Research andTreatment of Cancer (EORTC). Int J RadiatOncol Biol Phys 31(5): 1341–6.
2. Delaney G et al: The role of radiotherapy in cancer treatment. Cancer 2005.
3. Harris R et al: Radiotherapy skin care: A survey of practice in the UK. Radiography 2011.
Dressing discussed - PolyMem with support from Aspen Medical Europe Ltd.
Aspen 426(L)2 04.14 XS454
References:
Dressing evaluated: PolyMem®(Polymeric Membrane ) finger/toe dressing (Ferris Mfg Corp) Aspen Medical UK
Truman E (2011) Managing Radiotherapy Induced Skin Reactions A Toolkit for Healthcare Professionals Ellen Truman EWMA poster presentation (European wound Management Association)
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PRODUCTNEWS: SCARBAN
Hospithera verdeelt de producten Scarban van ScarPro NV
Hospithera is sinds kort de trotse distributeur van de silicone producten Scarban® van ScarPro NV.
Dit Belgische bedrijf staat al meer dan 60 jaar bekend voor de kwaliteit en effectiviteit van haar
producten.
De Scarban® Silicone sheets zijn uiterst geschikt voor de preventie en behandeling
van hypertrofische en keloïde littekens en voor de behandeling van brandwonden
(in monotherapie of in combinatie met druk). Dankzij de silicone herwint de huid
ook haar normale elasticiteit. Dit unieke gamma is beschikbaar in verschillende
types silicone en in verschillende vormen.
De Scarban® producten zijn:
• herbruikbaar van 15 dagen tot 2 maanden
• wasbaar (machine of hand)
• UV-beschermend
• zelfklevend en dubbel elastisch
• semi-occlusief
Effectiviteit van Scarban®:
VOOR
NA
Case I:
Trauma
Patiënt:Man
Oorzaak:Sportongeval
Case II:
Chirurgisch litteken
Patiënt:Vrouw
Oorzaak:Z-plastie
Case III:
Litteken
Patiënt:Kind
Oorzaak:brandwonde
Contacteer uw Account Manager voor meer informatie betreffende dit gamma!
5
PRODUCTNEWS: SANICAST
Reinigingskit voor onder een gipsverband
- Innovatieve oplossing om de huid
onder een orthopedisch gipsverband
te reinigen.
- Voor een betere hygiëne en minder
geurhinder.
- Desinfecteert, ontgeurt en verzacht
de huid.
Sani-Cast laat toe moeilijk te bereiken plaatsen onder een gipsverband
te reinigen en maakt zo het dragen van een gips comfortabel.
Sanicast is vanaf heden beschikbaar:
VOOR PROFESSIONALS:
Hospithera NV
Klein Eilandstraat 3
1070 Brussel
+32 (0)2 535 03 85
info.interventionalcare@hospithera.com
www.hospithera.com
VOOR PARTICULIEREN:
Home-Care BVBA
Domien Craccostraat 75
8800 Roeselare
+32 (0) 476.20.35.46
info@h-care.be
www.h-care.be
65
Het DayCare team van Hospithera wenst u een prettige zomer!
MEER INFORMATIE?
Contacteer ons!
Marc Lens
+32(0)476 86 35 15
marc.lens@
hospithera.com
Catherine Chauvin
+32(0)477 76 05 01
catherine.chauvin@
hospithera.com
Gladys D’Agostino
+32(0)483 57 60 24
gladys.dagostino@
hospithera.com
Nadine Delhez
+32(0)478 25 17 29
nadine.delhez@
hospithera.com
Hospithera NV l Klein Eilandstraat 3 l 1070 Brussel
Tel: +32 (0)2 535 03 85 l E-mail: info.interventionalcare@hospithera.com l WWW.HOSPITHERA .COM
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