EPUAP Review 5/3 RIP - European Pressure Ulcer Advisory Panel

epuap 

Mission Statement 

Executive Committee Members: 

Trustees: 

EPUAP Business Office: 

EUROPEAN PRESSURE ULCER ADVISORY PANEL 

Trustees of the European Pressure Ulcer Advisory Panel 

The European Pressure Ulcer Advisory Panel’s objective is to provide the 

relief of persons suffering from, or at risk of pressure ulcers, in particular 

through research and the education of the public. 

Denis Colin: President (France) 

Michael Clark: Recorder (Wales) 

Marco Romanelli: Past President (Italy) 

George Cherry: Secretary/Treasurer (England) 

Christina Lindholm (Sweden) 

Sue Bale (Wales) 

Brigitte Barrois (France) 

Andrea Bellingeri (Italy) 

Mark Collier (England) 

Theo Dassen (Germany) 

Carol Dealey (England) 

Tom Defloor (Belgium) 

Jacqui Fletcher (England) 

Katia Furtado (Portugal) 

Finn Gottrup (Denmark) 

Laszlo Gulacsi (Hungary) 

Jeen Haalboom (Netherlands) 

Ruud Halfens (Netherlands) 

Helvi Hietanen (Finland) 

Maarten Lubbers (Netherlands) 

Zena Moore (Eire) 

Elia Ricci (Italy) 

Anne Witherow (Northern Ireland) 

Administrator: Christine Cherry (England) 

68 Church Way 

Iffley, Oxford, OX4 4EF, UK 

Tel: +44 (0)1865 714358 

+44 (0)1865 228269 

Fax: +44 (0)1865 714373 

+44 (0)1865 228233 

E-mail: EuropeanPressureUlcerAdvisPanel@compuserve.com 

Volume 5, Number 3, 2003 77

78 

epuap 

Dr Michael Clark 


Letter from the Editor 

EDITORIAL 

THIS has been a busy year for the European Pressure Ulcer Advisory 

Panel – a successful conference held in Tampere, Finland along with 

a new guideline on nutrition and pressure ulcers mark just two of 

the year’s highlights. What does the New Year hold in store? First of all EPUAP 

are one of the co-hosts of the 2 nd World Union of Wound Healing Societies 

conference to be held in Paris over six days in July 2004 (8 th to the 13 th ). 

This will be the major wound event during the year and sees a coming together 

of several European wound organisations. It is expected that several 

thousand delegates will attend the Paris meeting – such numbers may be 

usual within many major medical conferences but this concentration of professions 

and skills within a single wound meeting is unique. What can EPUAP 

members expect from our participation within the World Union event? Although 

we are a co-host the main programme has been developed by the 

World Union committee and not by the EPUAP. This means that although 

pressure ulcers will be represented in depth during the conference there 

may be fewer opportunities for EPUAP projects to be reported within the 

main sessions. The potential lack of a focus upon the actions of the EPUAP 

will of course be offset by the opportunity to network with colleagues from 

almost all parts of the world! 

Another project in gestation during 2004 will be a pressure ulcer textbook 

prepared by the EPUAP and to be published by Springer-Verlag. This 

text will draw together the experience of EPUAP members to create a key 

publication on all aspects of pressure ulceration. Over the first few months 

of 2004 the Editors of this new book will be working with the chapter authors 

to bring the text to completion. A publication date has not yet been set 

but it is hoped that you will be able to obtain copies of this EPUAP text 

around the end of 2004. 

This issue of the EPUAP Review illustrates how EPUAP members have 

been helping to develop new evidence based consensus regarding support 

surface use in Italy. The article concludes with a call for members to get 

involved with this project by sharing their national and regional guidelines 

on support surfaces. There are now many guidelines available to help shape 

both pressure ulcer prevention and treatment; but which ones are worth 

adopting? Formal evaluation of pressure ulcer guidelines will also be a focus 

within this newsletter over the coming year; so watch out for how well your 

national guidelines compare with others! 

Michael Clark 

Editor 

Volume 5, Number 3, 2003

epuap Letter 

Denis Colin 


from the President 

Dear Friends, 

Ifeel very happy and proud to be the fourth President of the European 

Pressure Ulcer Advisory Panel. As the new President I wanted to take the 

opportunity to share my commitment for the vision and future of the 

EPUAP. First of all let us go back to our mission statement: ‘The EPUAP 

objective is to provide the relief of persons suffering from, or at risk of pressure 

ulcers, in particular through research and the education of the public’. 

To what extent have we met these objectives? Considerable progress has been 

made – through the EPUAP working groups, the EPUAP Review, our web site 

and of course the annual meetings which are always a large success in terms 

sharing knowledge and expertise. This year I believe the EPUAP made a 

decisive step during our seventh Open Meeting in Tampere where we asked 

‘have we made a difference?’ I am confident that we have indeed made that 

difference and would like to thank all those people who have been involved 

in making the EPUAP what it is today. However, we cannot be complacent, 

resting on past success. We have to continue to move forward towards our 

objective – the relief of persons suffering from pressure ulcers. 

In its short lifetime the EPUAP has also shown a model whereby we in 

Europe can work together for the common benefit of those who face pressure 

ulcers. This capacity for sharing and learning from one another is a key 

step towards winning the war against pressure ulcers and marks our unity 

throughout Europe and across the world. 

Happy new year 2004! 

Denis Colin 

President 


80 

epuap Report 

Clinical Need for this Guideline 

Pressure ulcers are the result of a complex interplay between 

myriad extrinsic and intrinsic risk factors – excessive 

mechanical loading, immobility, incontinence, advanced 

age among many others. While the consequences of immobility 

are often viewed as the key predisposing factors in 

prompting the development of a pressure ulcer, it is often 

assumed that there is also a direct causal relationship between 

nutrition and pressure ulcer development. The scientific 

basis for this assumption is unclear with as yet no 

sound studies linking impaired nutrition and an increased 

incidence of pressure ulcers. However, it is possible that 

impaired nutrition may influence tissue vulnerability to 

extrinsic factors such as pressure. It is important to note 

that only a few risk factors can be influenced by our actions 

– tissue loading and nutrition being two key issues we can 

address. The perceived importance of malnutrition in pressure 

ulcer development and management is briefly considered 

within existing EPUAP guidelines; for example: 

• A full risk assessment in patients to include: General 

skin condition, skin assessment, mobility, moistness 

and incontinence, nutrition and pain. 

• Following assessment nutritionally compromised 

individuals should have a plan of appropriate support 

and/or supplementation that meets individual needs 

and is consistent with overall goals of therapy. 

• Ensure adequate dietary intake to prevent malnutrition 

to the extent that this is compatible with the 

individual’s wishes or condition. 

The purpose of this guideline is to expand upon the 

references to malnutrition within existing EPUAP guidelines 

and provide clinicians with specific guidance upon 

nutritional screening and assessment and following assessment, 

appropriate intervention. It is intended that the 

guidelines be appropriate for all care settings although it is 

recognized that the access to specific tools such as weighing 

scales and personnel such as dieticians may be limited 

in some sectors. EPUAP recognize that other clinical guidelines 

on nutrition exist (for example: Obesity in Scotland, 

Integrating Prevention with Weight Management, SIGN 

Guideline no. 8, 1996) and that the specific guidance 

EPUAP offers on nutrition and pressure ulcers should be 

considered within the context of general guidelines on nutritional 

management. 


from the Guideline Development Group 

GUIDELINE ON NUTRITION IN PRESSURE ULCER PREVENTION AND TREATMENT 

Final version – Following helpful comments from Tampere meeting and EPUAP members 

Text prepared by Michael Clark on behalf of the Guideline Group, 16 November 2003 

The recommendations offered in this guideline have been 

graded using the following systems: 

Source of evidence that underpins the 

recommendation 

I Evidence from systematic review or meta-analysis of 

randomised controlled trials or at least one 

randomised controlled trial. 

II Evidence from at least one controlled trial without 

randomisation or at least one other type of quasiexperimental 

study. 

III Evidence from non-experimental descriptive studies, 

such as comparative studies, correlation studies and 

case-control studies. 

IV Evidence from expert committee reports or opinions 

and/or clinical experience of respected authorities. 

Recommendation Grading 

A Directly based on category I evidence. 

B Directly based on category II evidence or extrapolated 

recommendation from category I evidence. 

C Directly based on category III evidence or extrapolated 

recommendation from category I or II evidence. 

D Directly based on category IV evidence or extrapolated 

recommendation from category I, II or III 

evidence. 

Both grading systems were adapted from Eccles, M. and 

Mason, J. (2001). How to develop cost-conscious guidelines. 

Health Technology Assessment 5:8. 

Structure of the Guideline 

The recommendations of this guideline are considered to 

apply to both the prevention and management of pressure 

ulcers. Where guidance relates solely to pressure ulcer treatment 

this will be highlighted in the text. It should also be 

noted that the EPUAP considers all recommendations to 

be equally valid regardless of the grade of evidence upon 

which they are based. In the following recommendations 

where a source and level of evidence is not explicit, the 

recommendation should be considered as a level IV, D recommendation. 


Screening and Assessment of nutritional status 

Screening and assessment of an individual’s nutritional status 

can be performed using a number of measures ranging 

from tools such as the Subjective Global Assessment (Detsky 

et al 1987) to relatively simple measures of height and weight 

(combined as Body Mass Index). However, some measurements 

(height, laboratory tests, skin fold thickness) may not 

be readily available in all care settings. Undesired weight 

loss (>10% of normal body weight in the past six months, 

or >5% in the past month) may provide an indication of 

malnutrition although where possible reasons for this unintentional 

weight loss should be explored with the individual 

patient. 

Accurate measurement of body weight and height, and 

hence Body Mass Index, may be problematical in many settings 

through lack of available equipment or challenges in 

measuring body length among some patient groups. BMI 

measures have also been found to be less valid within some 

patient groups, such as children and the very elderly, due 

to their altered/different fat/lean body mass ratio. 

Recording patient weight should follow a specified protocol, 

where the individual is weighed ideally at the same 

time of day using the same scales with an appropriate weight 

range (up to 350kg). Before weighing, any outdoor clothes 

and shoes should be removed. If possible all weight measurements 

should be made by a single recorder. In addition 

to weight measurement, waist circumference is a reliable 

marker for intra-abdominal fat mass. The waist measurement 

should be carried out at a specific location half-way 

between the superior iliac crest and the rib cage, in the 

mid-axillary line. 

Nutritional assessment may also include nutritional intake 

over the past 1, 3 or 7 days; this information may be 

gathered using 24-hour recall, self or carer reported food 

intake records or through the involvement of a dietician, 

where available. It is important to consider why the intake 

of food and fluids is at the reported level. 

Biochemical measurements such as serum albumin, 

hemoglobin and potassium may be helpful when considering 

the nutritional status of the ill although these indicators 

may provide more information upon chronic, rather 

than acute depletion of specific nutrients. In general it is 

unlikely that biochemical measurements will provide more 

information than other indicators such as undesired weight 

loss although a number of studies cite an association between 

albumin and pressure ulcers. 

The use of nutritional screening or assessment tools appears 

to be becoming more prevalent in managing patients 

at risk of/with pressure ulcers. These tools require to be 

validated and reliable, and like general risk assessment tools 

should not replace clinical judgement. However the use of 

validated nutritional assessment tools may help to foster 

attention upon the need to consider nutrition when assessing 

vulnerability to pressure ulcer development. 

Nutritional status should be re-assessed regularly following 

an individualized assessment plan which includes an 

evaluation date. The frequency of assessment should be 

based upon the condition of the individual and should occur 

following specific events such as surgery and any development 

of infections or other catabolic processes likely to 

stress the nutritional status of the individual. 

REPORT FROM THE GUIDELINE DEVELOPMENT GROUP 

While looking at the individual patient the clinical judgement 

of appropriately trained health professionals may provide 

sound evaluations of probable nutritional status, it 

should be acknowledged that excess of body weight may 

mask nutritional deficiencies – for example morbidly obese 

individuals may still be malnourished. 

Nutritional intervention 

Where an assessment or screening of nutritional status indicates 

that malnutrition may be present, nutritional intervention 

should be considered. The primary goal of nutritional 

intervention is generally to correct protein-energy 

malnutrition ideally through oral feeding. When considering 

any limitations on normal food and fluid intake, consider 

the local environment such as ease of access to food, 

social and functional issues along with the texture of the 

diet. Changes in these aspects may encourage or facilitate 

increased oral intake. Overall the goal should be to consider 

the quality and energy-density of the food intake rather 

than its quantity. Considering fluid intake quantity is equally 

important as quality. 

Where enhanced normal feeding is not possible, protein-energy 

rich oral supplements may be considered (Recommendation 

1, B; Benati et al 2001, Bourdel-Marchasson 

et al 2000, Breslow et al 1993, Chernoff et al 1990, Delmi et al 

1990 ). The value of vitamin and trace element supplementation 

in pressure ulcer prevention is unclear (Recommendation 

1, B; Taylor et al 1974, ter Riet et al 1995). 

Where normal feeding and oral supplementation fail 

to resolve apparent malnutrition then other routes (for example 

tube-feeding) may be undertaken although the risks 

associated with these interventions should be considered. 

While the amount of supplementation required by individuals 

will vary, general guidance can be offered where 

an individual may require a minimum of 30-35 kcal per kg 

body weight per day, with 1 to 1.5 g/kg/day protein required 

and 1ml per kcal per day of fluid intake. 

Specific guidance on energy expenditure may be provided 

through the use of standard equations such as the 

Harris-Benedict or Schofield formulae although it is recommended 

that advice on their use and interpretation be 

sought from a dietician (where available) or the multidisciplinary 

care team. 

The success of nutritional intervention should be reviewed 

within the on-going regular nutritional assessments 

and may be indicated by outcomes such as increased weight 

or improved functional ability and/or enhanced healthrelated 

quality of life. Successful nutritional intervention 

may also be marked by a reduced incidence of new pressure 

ulcers and the healing of established pressure ulcers. 

Regular evaluation of the effects of nutritional interventions 

is required but it should be borne in mind that where 

individuals are malnourished the effects of feeding and/or 

supplementation may not be immediately apparent, probably 

because there first needs to be a restoration of already 

depleted reserves. 

Where patients have established pressure ulcers then a 

similar strategy of nutritional intervention should normally 

be considered (normal feeding, then oral supplements and 

finally tube-feeding) although the demands may be greater. 

There are a number of observations upon the role of nutri- 



tional deficiencies and pressure ulcer healing that can be 

extracted from controlled trials – protein and calorie supplementation, 

along with the use of arginine, vitamins and 

trace elements with antioxidant effects appear to have a 

positive effect on healing (Recommendation 1, B; Benati et 

al 2001, Bourdel-Marchasson et al 2000, Breslow et al 1993, 

Chernoff et al 1990, Delmi et al 1990). The evidence for the 

value of ascorbic acid supplementation is equivocal (Recommendation 

1, B; Taylor et al 1974, ter Riet et al 1995) and 

the evidence for zinc supplementation is weak (Recommendation 

1, B; Norris 1971). 

Specific issues may need to be resolved if normal feeding 

is to be enhanced – for example control of wound odour, 

altered body image, pain associated with the pressure ulcer 

and loss of self-esteem because these issues can reduce nutritional 

intake. 

Where individuals present with severe pressure ulcers 

(Grades 3 and 4) then the multidisciplinary team should 

consider their basal energy expenditure and pay particular 

attention to the increased fluid loss through such wounds. 

The nutritional requirements of specific groups may be 

different from those outlined in these guidelines, for example 

the spinal cord injured. 

Nutritional assessment and intervention should of 

course be combined with all other appropriate interventions 

including pressure management. 

These guidelines have not addressed several specific issues 

– nutritional assessment and intervention in neonates and 

paediatrics, the role of parenteral nutrition and specific 

needs of individual patient groups such as the immunosuppressed, 

those with cancers, orthopaedic, trauma and 

surgical patients and those who have experienced burns. 

Pharmacological interventions such as the use of anabolic 

steroids also are not included. 

In all of the preceding recommendations regarding nutritional 

assessment and supplementation all decisions 

should be taken with regard to patient choice and in light 

of the overall goals of treatment. 

Education 

There is a requirement for all staff (including but not limited 

to health professionals, untrained staff, catering and 

porters) to be aware of the importance of nutrition and to 

understand their role in improving the nutritional status of 

patients. This education will range from the performance 

of nutritional screening and assessment, the preparation 

of attractive, appetizing meals and the delivery and presentation 

of meals dependent upon the needs of individual 

staff members. There is a need to establish a nutritional 

culture within healthcare prompting the appropriate availability 

and presentation of meals through to continuity of 

nutritional care across departments and care settings. 

Summary of recommendations 

The EPUAP recommends that as a minimum, assessment 

of nutritional status should include regular weighing of 

patients, skin assessment, documentation of food and fluid 

intake. Additional procedures including anthropometric 

measurements and laboratory tests may also be performed 

82 

although these may best be viewed as more advanced assessment 

techniques. Nutritional intervention should focus 

upon improving the individual’s intake of food and fluids – 

through consideration of the quality of what is offered along 

with removing physical or social barriers to its consumption. 

Nutritional supplementation may be considered where 

it is not possible to enhance the individual’s own consumption 

of food and fluids. 

References used in the development of this guideline 

American Society for Parenteral and Enteral Nutrition Board of 

Directors. Definition of terms used in ASPEN guidelines and 

standards. JPEN 1995;19:1-2. 

Benati G, Delvecchio S, Cilla D, and Pedone V. Impact on 

pressure ulcer healing of an arginine enriched nutritional 

solution in patients with severe cognitive impairment. Arch 

Gerontol Geriatr, 2001, 33 Suppl 1, 43–47. 

Bourdel-Marchasson I, Barateau M, Rondeau V, Dequae- 

Merchadou L, Salles-Montaudon N, Emeriau JP, Manciet G, 

and Dartigues JF. A multicenter trial of the effects of oral 

nutritional supplementation in critically ill older inpatients. 

GAGE Group. Groupe Aquitain Geriatrique d’Evaluation. 

Nutrition, 2000, 16(1), 1–5. 

Breslow RA, Hallfrisch J, Guy DG, Crawley B, & Goldberg AP. 

The importance of dietary protein in healing pressure 

ulcers. J Am Geriatr Soc, 1993, 41(4), 357–362. 

Chernoff RS, Milton KY, & Lipschitz DA. The effect of a very 

high protein liquid formula on decubitus ulcers healing in 

longterm tubefed institutionalised patients. J Am Diet Assoc, 

1990, 90, A–130. 

Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, and Bonjour 

JP. Dietary supplementation in elderly patients with fractured 

neck of the femur. Lancet, 1990, 335(8696), 1013–16. 

Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, 

Mendelson RA and Jeejeebhoy KN. What is subjective global 

assessment of nutritional status? J. Parenter. Enteral Nutr., 

1987, 11: 8-13 

Gray-Donald K, Payette H, Boutier V. Randomized clinical trial of 

nutritional supplementation shows little effect on nutritional 

status among free-living frail elderly. J Nutr 1995; 125(12): 

2965-71 

Green CJ. Existence, causes and consequences of disease related 

malnutrition in the hospital and the community, and clinical 

and financial benefits of nutritional intervention. Clinical 

Nutrition 1999;18(Supp 2):3-28. 

Keele AM, Bray MJ, Emery PW et al. Two phase randomized 

controlled clinical trial of postoperative oral dietary 

supplements in surgical patients. Gut 1997;40:393-399. 

Langer G, Schloemer G, Knerr A, Kuss O, Behrens J. Nutritional 

interventions for preventing and treating pressure ulcers 

(Cochrane Review). In: The Cochrane Library, Issue 4, 2003. 

Chichester, UK: John Wiley & Sons, Ltd. 

Lipschitz DA, Mitchell CO, Steele RW et al. Nutritional evaluation 

and supplementation of elderly subjects participating in 

a ‘meals on wheels’ program. JPEN 1985;9:343-7 

Mathus-Vliegen EMH. Nutritional status, Nutrition and Pressure 

Ulcers. Nutrition in Clinical Practice 2001; 16:286-291. 

Norris JR & Reynolds RE. The effect of oral zinc sulfate therapy 

on decubitus ulcers. J Am Geriatr Soc, 1971, 19, 793–797. 

Robinson G, Goldstein M, Levine GM. Impact of nutritional 

status on DRG length stay. JPEN 1987; 11: 49-52 

Taylor TV, Rimmer S, Day B, Butcher J, and Dymock IW. 

Ascorbic acid supplementation in the treatment of 

pressuresores. Lancet, 1974, 2(7880), 544–546. 

ter Riet G, Kessels AG, and Knipschild PG. Randomized clinical 

trial of ascorbic acid in the treatment of pressure ulcers. J 

Clin Epidemiol, 1995, 48(12), 1453–1460. 

The EPUAP would suggest that a sound starting point for further 

exploration of the links between nutrition and pressure 

ulcers would be the publication: 

Mathus-Vliegen EMH. Nutritional status, Nutrition and Pressure 

Ulcers. Nutrition in Clinical Practice 2001; 16: 286-291. 


epuap 

WELCOME TO TAMPERE 

Opening speech by Kati Myllymäki 

THE EPUAP Open Meeting held in Tampere during 

September 2003 was officially opened by Kati 

Myllymäki. The following text reproduces her opening 

address to the meeting and the EPUAP would like to 

thank Kati and all our Finnish colleagues for their hospitality 

and warm welcome in Tampere. 

Distinguished experts, my dear colleagues and friends, ladies 

and gentlemen; it is my pleasure and honour to welcome 

you all to Tampere and to Finland for this meeting of 

the European Pressure Ulcer Advisory Panel. 

The topic of this conference – Pressure Ulcer Prevention 

and Management is of the utmost importance. This 

area poses many challenges when I look at it with the eyes 

of a general practitioner in elderly care. We are trying to 

alleviate suffering of our patients when we first fail in prevention 

and after this first failure difficulties continue if 

their care and treatment is not appropriate. And when these 

problems accumulate and when problems stretch, the waiting 

lists to specialized care may be unreasonably long. 

With the eyes of administrator or even as a tax-payer we 

see that a focus upon the wrong issues – such as impaired 

rehabilitation, shortages of devices for the paralysed and 

immobile, a lack of hospice personnel and out-dated professional 

knowledge lead to increasing expenses, hospitalisation 

and great human suffering. 

It is delightful to see that the European Pressure Ulcer 

Advisory Panel is working hard to develop deeper understanding 

and evidence-based knowledge of this problem, 

and also is striving to spread this information to all professionals 

working in this field. 

In recent World Health Organization meetings the 

health ministers of the world have noted that an intersectoral 

approach to prevention strategies involving partnerships 

with communities, nongovernmental organizations, 

local government and private sector organizations (such as 

the EPUAP) is of utmost importance. In this field we do 

need to foster public awareness and responsible attitudes 

of all social and health professionals and decision-makers. 

As I am working for the Finnish National Health Care 

Project for our Ministry of Health, I must say a few words 

about money – the costs of health care. Globally we see that 

the rapidly changing age structures of many populations 

will lead to changing risk profiles in the coming decades. 

National social and health care services are challenged by 

aging populations, increasing health care costs and – luckily 

– also by improving medical technology. 


Open Meeting, Tampere, Finland 2003 

This Spring, the WHO general assembly unanimously 

accepted the Framework Convention on Tobacco Control 

and I am sure this expert audience here is very well aware 

of the effect of smoking on our skin’s blood circulation and 

the ability of our tissues to heal and recover when lacking 

oxygen. I wish that as health professionals you can also keep 

this congress smoke-free! 

A diabetes epidemic is also underway. As the number of 

people with diabetes grows worldwide, the disease takes an 

ever-increasing proportion of national health care budgets. 

Without primary prevention, the diabetes epidemic will 

continue to grow. Even worse, diabetes is projected to become 

one of the world’s main disablers and killers within 

the next twenty-five years. Immediate action is needed to 

stem the tide of diabetes and to introduce cost-effective treatment 

strategies to reverse this trend. An estimated 30 million 

people world-wide had diabetes in 1985. The latest 

WHO estimate (for the number of people with diabetes, 

world-wide, in 2000) is 177 million. This will increase to at 

least 300 million by 2025 – that is only 20 years from now! 

And you surely know what diabetes does to vulnerability to 

skin problems and ulcers. 

Ladies and gentlemen, we all know that prevention of a 

health problem is usually the cheapest option. On the other 

hand it is often the most difficult. From the time of Hippocrates 

to our own time and World Medical Association 

declarations: prevention is our ethical obligation. It is unfortunate 

that health care budgets or fee-for service systems 

seldom reward preventive work. Prevention is a major 

task for both health care professionals and experts in education, 

ordinary citizens and of course political decisionmakers. 

To tackle the great risk factors of ageing population 

(osteoporosis, hip-fractures, over-weight, diabetes, 

smoking, strokes) we need to change our own living habits. 

It will be much more expensive to respond to these challenges 

with pharmaceuticals, surgical operations and technological 

device when complications already exist. 

On behalf of the Ministry of Social Affairs and Health 

in Finland I wish you all an enjoyable stay in Tampere and a 

successful meeting. I am sure that all health care professionals 

and all our patients look forward to the information 

and advice you will provide for us. 

And I wish that you will also have the opportunity to 

take care of your personal mental and physical and social 

well-being – prevention or health promotion – while staying 

in this beautiful city. 


FEBRUARY 2004 

15 Oxford International Wound Healing 

Federation Meeting 

Baroda, India 

Contact: oxfordwound@aol.com 

16 Oxford International Wound Healing 

Federation Meeting 

Pramumukhswami Medical College, and Sri 

Krishna Hospital, Karamsad, India 

Contact: oxfordwound@aol.com 

MARCH 2004 

12 – 13 The Different Aspects of the Venous Leg Ulcer 

Copenhagen Wound Healing Center 

Bispebjerg University Hospital 

Copenhagen, Denmark 

Contact: www.cwhc.dk 

MAY 2004 

2 – 5 17th Symposium on Advanced Wound Care 

Disney’s Coronado Springs Resort 

Orlando, Florida, USA 

Contact: www.woundcaresymposium.com 

84 

epuap 


Future Meetings 

JUNE 2004 

9 – 12 49th Annual Meeting of the Plastic Surgery 

Research Council 

Ann Arbor, Michigan, USA 

Executive Office: 45 Lyme Road 

Suite 304, Hanover, 

NH 03755, USA 

JULY 2004 

8 – 13 2nd World Union of Wound Healing Societies 

Meeting · Paris, France 

MF Congress, Contact: Mr Bia 

8 rue Tronchet, 75008 Paris, France 

Tel: +33 140 07 11 21 Fax: +33 140 07 10 94 

Web: http://www.wuwhs.org 


epuap News 


from the Business Office 

DIRECTORS’ REPORT AND FINANCIAL STATEMENT 

For the Year Ended 30 June 2003 

Report of the Charity 

The activity over the last year has continued to expand on 

the previous years work to reflect the Charity’s objective ‘to 

provide the relief of persons suffering from, or at risk of 

pressure ulcers in particular through research and education 

of the public’. The EPUAP Review, the charity’s journal 

has been published three times and the EPUAP website 

(www.epuap.org) has expanded. The dissemination of 

knowledge on the prevention and management of pressure 

ulcers is provided daily through our Business Office by supplying 

the EPUAP guidelines as well as forwarding questions 

from our website to relevant experts in the field. 

Our very successful annual meeting was held in Budapest, 

Hungary in September 2002 with its theme: Pressure 

ulcers – a quality of care indicator? As in previous years the 

quality of the scientific programme was excellent as well as 

challenging. Preliminary results from the Pan European Pressure 

Ulcer Study were given by Christina Lindholm’s group 

and the new Dutch pressure ulcer guidelines were presented. 

The results of the EPUAP’s Prevalence Survey were also presented 

by Tom Defloor. The EPUAP subsidised a number of 

Eastern European medical professionals to attend the meeting 

and also to present their work to further our mission 

statement. The Lifetime Achievement Award was presented 

to Professor J. Barbanel from Scotland a well known and 

stimulating figure in the field of pressure ulcers. 

We were saddened at the death of a founding trustee 

and our first Recorder, Professor Gerry Bennett of London, 

who enriched the panel with his enthusiasm and expertise 

which contributed greatly to the success of our charity. He 

instituted a working party following last year’s annual meeting 

on nutrition and pressure ulcers which led to a major 

unconditional educational grant from Nutricia to develop 

guidelines on this important aspect of pressure ulcer management. 

The charity did recognise him last year in Budapest 

by acknowledging his contribution to the EPUAP. Following 

Gerry’s death Michael Clark assumed the chair of 

this working group and has since had two meetings which 

have resulted in the draft of preliminary nutritional guidelines. 

This draft will be presented at the Annual Meeting in 

Tampere in September 2003 for suggestions and criticisms 

from members of the EPUAP. 

A Trustees Meeting weekend was held on March 22–23, 

2003 with the majority of Trustees being present. The meeting 

was moderated by Keith Harding, the first President of 

EPUAP. 

Dr George Cherry 

The purpose of the meeting was to make an action plan 

for the future growth of the EPUAP. Although the Open 

meeting in Budapest was a huge success it was thought that 

there was still a perception that the EPUAP was a closed 

society, despite having 350 paying members and it was decided 

that we needed to market the panel to increase both 

awareness of the public and funding. Four groups had been 

identified at a previous Trustees Brainstorming meeting in 

January 2002: 

1. Administration – chair Jacqui Fletcher 

The purpose of this group was to identify the means 

of streamlining the administration of the EPUAP and 

also to note the qualities of all present trustees. It was 

decided to keep an accurate register of all details 

related to trustees and that a criteria of entry as a 

trustee should be formulated. This has now been 

completed and will be presented at the next Annual 

General Meeting for ratification by members of the 

panel. 

2. Education – chair Sue Bale 

It was thought that much research had been undertaken 

by the panel in the past two years. Such as the 

prevalence, PEPUS and support surface studies, but 

education of the public now needed to be seriously 

addressed. Courses for patients, carers and health 

care workers were to be organised at three levels, 

simple, intermediate and advanced. It was suggested 

that a grading system with photographs should be put 

on the website to aid in the identification of classification 

of pressure ulcers. This has now been successfully 

initiated and CDs of this grading system will be 



86 

distributed to all attendees at the September 2003 

meeting in Tampere Finland. Collation of educational 

material from all European countries is also ongoing. 

3. Activities – chair Michael Clark 

This group is responsible for activities within the 

EPUAP and the setting up of venues for annual 

meetings. Lists of working groups are also collated by 

this group. 

4. Profiling Chair – Gerry Bennett 

(Christina Lindholm assumed the chair when Gerry Bennett 

became ill). 

This group had not had a chance to meet and it was 

felt was completely dependent on other groups. We 

need to involve key members of the European Union 

and European Economic Community to again assist 

with publicity etc. 

At the Trustees meeting in Oxford in March considerable 

discussion was led by Carol Dealey and Jacqui Fletcher on a 

document which they drew up suggesting new requirements 

to qualify as a trustee of the EPUAP. Initially when the panel 

was formed and made into a charity the founders thought 

it important to include trustees from the majority of the 

EEC countries in order to live up to the ‘European’ aspect 

of the charity’s name. The new document stresses the importance 

of expertise in pressure ulcers as a requirement 

for being a trustee. However, it could be argued that we 

should expand this to other individuals such as patients or 

people who have proven administrative abilities that would 

continue the success of the EPUAP. The changes for requirements 

to be a trustee will be discussed at our Annual 

General Meeting in Tampere Finland in September 2003 

for ratification. 

The EPUAP funded its President-elect Denis Colin to 

attend the meeting of our sister organisation NPUAP in 

New Orleans, USA. 

George Cherry who had been contacted several times 

by the press for information on pressure ulcers and the late 

Gerry Bennet who was leader of the ‘Elder Abuse’ charity 

decided that more publicity was needed to highlight this 

huge problem in Europe. The results of our European 

prevalence study on pressure ulcers was given to the press 

by Michael Clark following press inquiries to the Business 

Office. This resulted in press and radio publicity. 

In order to meet the mission statement regarding public 

awareness a special publicity meeting was held in Oxford 

in March to draw up plans on how to increase the awareness 

of pressure ulcers in UK as in other countries such as 

the Netherlands and Sweden this has already been addressed. 

We were fortunate again that Hilary Scott from 

the Complaints and Clinical Negligence Office for the NHS 

was able to be present and share her knowledge. In addition 

representatives from our corporate sponsors as well as 

specialised wound healing journals; The Journal of Wound 

care which was represented by the editor Deborah Glover, 

were present so that the EPUAP could utilise their professional 

experience. 

Following this meeting all Members of the British Parliament 

have now been circulated with the results of the 

European Prevalence survey carried out by the EPUAP 

which indicates that one in five hospital patients may have 

pressure ulcers. The healing of these ulcers is costly and 

time consuming as well as giving the patient and in some 

cases his/her carers poor quality of life. We are in the process 

of circulating the European Parliament with these results. 

Early responses acknowledging receipt of this publicity 

information from British Members of Parliament including 

the Prime Minister have been received. 

One of the major roles of the Secretary/Treasurer since 

the EPUAP has been founded has been that of raising funds 

for the charity. These have mainly come from our corporate 

sponsors, annual meeting support from Industry, delegates 

fees and subscription fees for membership. With regard 

to the latter, as previously stated we have more than 

350 members whose renewal subscriptions and certificates 

of membership are processed through the Business Office. 

The success of this endeavour has come from the excellent 

support of the Business Office personnel, Jane Green and 

Christine Cherry. All of the EPUAP annual meetings have 

been organised through the Business Office. The revenues 

of these meetings are in the attached Charity Commission 

Report and accounts and because our financial year ends 

on June 30, so that the report can be circulated at the Annual 

General Meeting in September, the revenue from each 

meeting is carried over into the next financial year. 

The EPUAP Business Office continues to be an essential 

part of the structure of the EPUAP. Subscriptions for 

membership, Industry subscriptions and mailing lists are 

all co-ordinated as well as mailings for meetings, publication 

of the EPUAP Review, collation of data regarding working 

groups etc. Queries from the web regarding patients 

are sent to relevant trustees to the nearest destination of 

the patient’s home. The annual meeting is arranged from 

within the business office. This includes obtaining the programme 

from the scientific committee, liaising with the 

Recorder with regards to speakers, organising satellite meetings 

and arranging travel for invited speakers. It also entails 

making site visits to the proposed venues for the meetings. 

Next year the annual meeting will take place in Paris, 

France, 8–13 July 2004 as part of the 2 nd World Union of 

Wound Healing Societies’ meeting. The EPUAP is one of 

the four co-hosting societies which enables us to obtain a 

portion of the revenues from that meeting. The EPUAP is 

playing a major part in the organisation of the scientific 

programme where it pertains to pressure ulceration. 

The Trustees of the EPUAP are in the early stages of 

writing a book on the prevention and treatment of pressure 

ulcers which is being led by our president Marco 

Romanelli. 

In summary the European Pressure Ulcer Advisory Panel 

continues to be successful in achieving its mission statement 

but still has considerable work to do as long as pressure 

ulcers continue to be a major economic and health problem. 

This report has been prepared in accordance with special 

provisions of Part VII of the Companies Act 1985 relating 

to small companies. 

Dr George W Cherry 

Secretary / Treasurer 

18 August 2003 BY ORDER OF THE BOARD 


EUROPEAN PRESSURE ULCER ADVISORY PANEL CHARITY 

STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 30 JUNE 2003 

Nutricia 

Guidelines 

Note Restricted Unrestricted Unrestricted 

Fund Funds Funds 

2003 2003 Total 2002 

INCOME AND EXPENDITURE £ £ £ £ 

Incoming Resources 

Subscriptions – individual – 15260 15260 10390 

corporate – 58468 58468 29912 

Conference Income 2. – 106121 106121 57067 

Interest Receivable – 697 697 1045 

Research and Grants 13992 – 13992 12000 

______ ______ ______ ______ 

Total Incoming Resources 13992 180546 194538 110414 

–––––– –––––– –––––– –––––– 

Resources Expended 

Charitable Expenditure 

Nutricia Guidelines 3496 – 3496 – 

Committee Meetings – 6319 6319 7983 

Awards made – 28 28 158 

Prevalence Study Meetings – 520 520 5889 

Secretarial and Office Expenses – 39342 39342 19002 

Publication Expenses – 12130 12130 14359 

Conferences and Meetings Expenses 2. – 103379 103379 63036 

Computer Support – 3405 3405 1950 

Advertising – 516 516 – 

NPUAP Conference – 1313 1313 – 

Project Work – 534 534 – 

Attendance by overseas delegates – 1710 1710 – 

Accountancy – 1366 1366 1207 

Bank Charges – 1570 1570 1238 

Depreciation – 679 679 942 

Management and Administration of the Charity – 1928 1928 1000 

______ ______ ______ ______ 

Total Resources Expended 3496 174739 178235 116764 

–––––– –––––– –––––– –––––– 

Net Incoming/(Outgoing) Resources 10496 5807 16303 (6350) 

Fund Balances brought forward – 16583 16583 22933 

______ ______ ______ ______ 

Fund Balances carried forward 10496 22390 32886 16583 

The above represents the recognised gains and losses of the charity. 

REPORT FROM THE EPUAP BUSINESS OFFICE 

–––––– –––––– –––––– –––––– 



BALANCE SHEET AT 30 JUNE 2003 

Note 2003 2002 

£ £ £ £ 

Fixed Assets 3. 2225 2904 

Current Assets 

Cash at Bank 68552 46225 

Prepayments 4. 24237 9601 

______ ______ 

92789 55826 

Current Liabilities 

Accruals and Deferred Income 5. (62128) (42147) 

______ ______ 

Net Current Assets 30661 13679 

_____ _____ 

Net Assets 32886 16583 

_____ _____ 

Represented by: 

Restricted Fund 6. 10496 – 

Unrestricted Funds 7. 22390 16583 

_____ _____ 

These financial statements have been prepared in accordance 

with the special provisions of Part VII of the Companies 

Act 1985 relating to small companies and the Financial 

Reporting Standard for Smaller Entities (effective June 

2002). 

The directors are satisfied that the company was entitled 

to exemption under subsection (1) of section 249A of 

the Companies Act 1985 and that members have not required 

an audit in accordance with subsection (2) of section 

249B. 

The directors acknowledge their responsibilities for: 

a) ensuring that the company keeps accounting records 

which comply with section 221; and 

b) preparing accounts which give a true and fair view of 

the state of affairs of the company as at the end of the 

financial year and of its profit or loss for the financial 

year in accordance with the requirements of section 

226, and which otherwise comply with the requirements 

of this Act relating to accounts, so far as 

applicable to the company. 

These financial statements were approved on behalf of the 

charity on 18 August 2003. 

Signed on its behalf by _______________________________ 

88 

George Cherry – Secretary/Treasurer 

32886 16583 

______ ______ 

NOTES TO THE ACCOUNTS FOR THE YEAR 

ENDED 30 JUNE 2003 

1. Accounting Policies 

The following accounting policies have been applied consistently 

in dealing with items which are considered material 

in relation to the charity’s financial statements. 

a) Company Status 

The charity is a company limited by guarantee. The 

members of the company are the trustees. 

b) Basis of Preparation 

The financial statements have been prepared under 

the historical cost accounting rules, and in accordance 

with the Charities SORP and the Financial 

Reporting Standard for Smaller Entities (effective 

June 2002). 

c) Income and Expenditure 

Income and Expenditure is accounted for on an 

accruals basis. Subscription income is apportioned 

over the period to which it relates. 

d) Tangible Fixed Assets 

Tangible fixed assets are stated at historical cost less 

depreciation. Depreciation is provided using the 

reducing balance basis at rates which reflect the 

anticipated useful lives of the assets and their estimated 

residual values: 

Office Equipment 15% 

Computer Equipment 331 /3% 


2. Annual Conference 

Income £ 

From Corporate Sponsors 38495 

Satellite meeting 10500 

From individual registrations 52126 

From Convatec for programmes 5000 

______ 

106121 

Less: expenditure (103379) 

______ 

Surplus on Conference 2742 

3. Fixed Assets Office Computer 

Equipment Equipment Total 

£ £ £ 

Costs: 

Brought Forward 2457 2823 5280 

Additions – – – 

_____ _____ _____ 

Carried Forward 2457 2823 5280 

_____ _____ _____ 

Depreciation: 

Brought Forward 883 1493 2376 

Charge 236 443 679 

_____ _____ _____ 

Carried Forward 1119 1936 3055 

_____ _____ _____ 

Net Book Value: 

As at 30 June 2003 1338 887 2225 

As at 30 June 2002 1574 1330 2904 

_____ _____ _____ 

4. Prepayments 

Included within prepayments is an amount of £18,168 relating 

to expenses incurred for the Tampere Meeting being 

held in September 2003. 

5. Accruals and Deferred Income 2003 2002 

£ £ 

Accountancy and Professional Fees 1300 1250 

Deferred Income 60828 40897 

_____ _____ 

62128 42147 

_____ _____ 

During the year subscriptions were received from individual 

members covering the subscription year ending 30 September 

2003 and corporate members covering the subscription 

year ending 31 December 2003. As these financial statements 

have been prepared to 30 June 2003 the element of 

subscriptions paid in advance at that date amounting to 

£43,604 has been treated as deferred income. 

REPORT FROM THE EPUAP BUSINESS OFFICE 

6. Restricted Fund 

This is a specific grant from Nutricia for the production of 

Nutritional guidelines 

7. Trustees Expenses 

Fifteen Trustees were reimbursed for their expenses, 

amounting to £25733 (2002 : £12976). 

ACCOUNTANTS’ REPORT 

ON THE UNAUDITED ACCOUNTS 

To the Members of the EUROPEAN PRESSURE ULCER 

ADVISORY PANEL CHARITY 

We report on the accounts for the year ended 30 June 2003 

set out above. 

Respective Responsibilities of Directors and Reporting 

Accountants 

As described above the trustees, who are also the directors 

of European Pressure Ulcer Advisory Panel Charity for the 

purposes of company law, are responsible for the preparation 

of the accounts, and they consider that the company is 

exempt from an audit. It is our responsibility to carry out 

procedures designed to enable us to report our opinion. 

Basis of Opinion 

Our work was conducted in accordance with the Statement 

of Standards for Reporting Accountants, and so our procedures 

consisted of comparing the accounts with the accounting 

records kept by the company, and making such limited 

enquiries of the officers of the company as we considered 

necessary for the purposes of this report. These procedures 

provide only the assurance expressed in our opinion. 

Opinion 

In our opinion: 

a) the accounts are in agreement with the accounting 

records kept by the company under section 221 of the 

Companies Act 1985; 

b) having regard only to, and on the basis of, the 

information contained in those accounting records: 

(i) the accounts have been drawn up in a manner 

consistent with the accounting requirements specified 

in section 249C(6) of the Act; and 

(ii) the company satisfied the conditions for exemption 

from an audit of the accounts for the year 

specified in section 249A(4) of the Act and did not, at 

any time within that year, fall within any of the 

categories of companies not entitled to the exemption 

specified in section 249B(1). 

ABINGDON, OXON, UK Critchleys 

19 August 2003 Chartered Accountants 


CLINICAL BENCH-MARKING – MAKING A 

DIFFERENCE THROUGH TEAM WORK 

Jackie Stephen-Haynes RGN DN DipH BSc(Hons) Masters in 

Clinical Nursing 

Lecturer and Practitioner in Tissue Viability for 

Worcestershire Primary Care Trusts and University College 

Worcester. Stourport Health centre, Worcester St, Stourport 

on Severn, Worcestershire. DY13 8EH Tel: 07775–792775 

Jackies_h@btopenworld.com 

Introduction 

The aim of this presentation is to highlight the constructive 

effect clinical benchmarking can have in making a difference 

to pressure ulcer prevention and management. 

Clinical benchmarking was defined as a process through 

which best practice is identified and continuous improvement 

pursued through comparison and sharing. 

Method 

A project was undertaken in the three Worcestershire Primary 

Care Trusts with representation from each of the six 

community hospitals and each of the nine areas within the 

county. Clinical benchmarking begins to challenge and legitimises 

the fundamentals of nursing practice. It does this 

by questioning our application of evidence-based healthcare 

‘what we know’ and ‘what we do’. 

To facilitate the implementation of benchmarking with 

a determination to improve clinical practice I have worked 

with the Institute of reflective practice utilising their colearning 

in practice as a framework to develop the team. 

We have undertaken a detailed understanding of the culture 

of the workplace and factors that assist or hinder them 

in taking practice forward, identified their own position in 

terms of taking practice forward in Tissue Viability, identified 

how it was possible to gain help from colleagues within 

the team. 

Results 

The team developed a mission statement; ground rules and 

audit tools based upon the clinical benchmarks. All team 

members have undertaken an audit of the 9 clinical benchmark 

factors within each community hospital and in each 

area of the community. 

The audits have clearly identified the areas for practice 

that can be improved and staff have acknowledged that some 

90 

epuap Poster 


Abstracts from Tampere 

7TH EPUAP OPEN MEETING, TAMPERE, FINLAND 

Pressure Ulcer Prevention and Management, Poster Abstracts, September 2003 

changes make more effective use of resources and that not 

all changes require extra funding. 

Each team has developed a Clinical-benchmarking 

folder of evidence, which includes National and local policy 

and guidelines, Clinical benchmarking audit tools, results, 

implications for practice, practical implementation, education 

and research, and patient information leaflet. 

Summary 

Together the team is utilising clinical benchmarking to take 

practice forward. A plan has been developed from both a 

strategic and practical implementation perspectives. The 

audit have demonstrated that we have made a difference in 

pressure ulcer prevention and management and key areas 

for future improvement have been identified. 

DEVELOPMENT OF AN EASY DECISION TREE 

FOR THE SELECTION OF A COMFORTABLE 

SUPPORT SURFACE WITHIN THE SCOPE OF 

THE GERMAN HEALTH SYSTEM FOR THE 

HOME CARE PATIENTS 

P Diesing, D Hochmann and U Boenick. 

Technical University of Berlin, Department if Biomechanical 

Engineering, Berlin, Germany 

Paticipants of the BVMed – Workgroup – U Gabler (ADL), 

A Bugs (Air-systems), H-J Flohr (Gerromed), E Goller (Hill- 

Rom), B Billen (ROHO), D Piossek (BV Med), P Diesing 

(TU Berlin) 

Introduction 

German law defines the rules supplying support surfaces to 

non-hospital patients with a high risk for pressure ulcer in 

the SGB V (Sozialgesetzbuch V). This law stipulates that for 

the reimbursement of the costs for a support surface, the 

product must be included in the German list of technical 

aids (Hilfsmittelverzeichnis), which was developed by the 

health insurances. The classification for this list is fixed by 

the organisation of the health insurances. The essential 

question, which support surface is the right one for which 

patient is not answered by this documentation. 

Because of a revision to this list, the companies selling 

those products have designed, under the leadership of the 

BVMed and the TU Berlin, a decision tree, a new classification 

and a glossary, which should help the health insurances 

to select the right support surface for the patient. 


Methods 

The main idea behind the classification is that the decision 

for a support surface should be based on the risk of developing 

a pressure ulcer or on the risk that a pressure ulcer 

will not heal. It should not generally be based on the grade 

of an existing ulcer. This should help avoiding high costs 

with pressure ulcers by having an adapted prevention. The 

formal decision tree is based on the decision tree used in 

the USA for the last year. For the support surfaces, it is differentiated 

between: 

Mattresses vs. overlay 

Powered vs. non-powered devices 

Special features within the different groups. 

The decision tree and the decision rules are worked out 

in meetings with the companies AirSystems, ADL, Gerro- 

Med, Hill-Rom and ROHO. The responsible person from 

the BVMed and scientists from the TU Berlin also participated 

in this workgroup. 

Results 

As a result of this process, a decision tree was established 

with something similar to an instruction for use, a classification 

of support surfaces based on technical features of 

the products, and a glossary which defines and explains the 

products. This information is bundled in a brochure, which 

should be printed by the BVMed and should also be available 

on the Internet. 

The rules used for the decision tree could not be fixed 

by evidence-based medicine, but rather by the consensus 

of the clinical experience of the participants. 

Summary 

The presented classification is intended to lead in the direction 

of an evidence-based decision tree for support surfaces. 

However, with the currently existing studies it is not 

possible to define rules that allow an accurate evidencebased 

choice of a support surface. 

For the health insurance companies this decision tree 

allows to choose a product based on a clinical consensus. 

In the future the rules should be checked by several 

randomised trials. 

Contact: diesing@bmt1.kf.tu-berlin.de 

A NEW MODULAR TEST SYSTEM FOR THE 

MECHANICAL AND MICROCLIMATIC 

EVALUATION OF SUPPORT SURFACES 

P Diesing, D Hochmann and U Boenick. 

Technical University of Berlin, Department if Biomechanical 

Engineering, Berlin, Germany. 

Introduction 

The evaluation of the mechanical and microclimatic properties 

of support surfaces is important for various groups. 

The manufacturer wants to optimise his products for the 

best pressure relief and good microclimatic properties. The 

nurse in the hospital wants to know if a system works correctly 

with, for example, obese or heavily perspiring patients. 

The health insurances want to pay only for products that 

have a clinical effect. Due to the lack of clinical studies for 

all products in this field, these groups requested standard- 

POSTER ABSTRACTS FROM TAMPERE, 2003 

ised laboratory tests to predict the clinical effect of a system. 

In answer to this request, a project was initiated at the 

TU Berlin (funded by the Otto-Bock-Stiftung) to perform 

clinical tests, construct test equipment and try to correlate 

the results to a new test standard for support surfaces. 

Methods 

The main idea was to develop a test machine that is able to 

perform all necessary tests to characterize support surfaces. 

Due to its modular design, the machine can test both cushions 

and mattresses. The machine consists of a frame with a 

controlled driving unit and interchangeable modules for 

the different parameters. The modules should be designed 

for the mechanical and thermal stresses with pressure, shear, 

temperature and humidity. Those parameters should be 

controlled within physiologic and pathologic ranges. The 

modules are designed to be as simple as possible and should 

simulate the conditions of a human body in a standardized 

and reproducible way. The limit values have been acquired 

in clinical tests of geriatric patients. The effect of these experiments 

is detected by the same sensor that was used beforehand 

for the acquisition of the clinical data 

Results 

The test machine built worked as intended. An important 

feature is that the output of the machine could be adapted 

in a wide range to the requirements of the evaluation. Even 

though the conditions at the patient cannot be emulated 

in a completely physiological way, the resulting ranking was 

the same as in volunteer trials. The tests characterize the 

support surfaces in terms of their microclimate and mechanical 

properties. On the other hand, the first results 

showed that the standard deviation of these properties in 

this test procedure is much smaller than that of volunteer 

tests. This makes it much easier to create a reproducible 

standard for those tests. 

Summary 

The developed test machine increases the reproducibility 

of the evaluation results for support surfaces. The device 

can be easily adapted to different test procedures for different 

parameters. The use of the same sensors as in the clinical 

tests for microclimate and pressure mapping eliminates 

errors in the measurement technique. Based on the results 

of the clinical trial with geriatric patients, which should be 

finished at the end of the year, a classification for the different 

parameters should be adapted. This classification should 

improve the prediction of which support surfaces can improve 

the outcome of the patients. 

Contact: diesing@bmt1.kf.tu-berlin.de 

A CLINICAL EVALUATION OF THE KCI 

PROFICARE MATTRESS REPLACEMENT 

SYSTEM 

Fiona Collins 

Tissue Viability Consultancy Services Ltd, Eastbourne, 

England 

Introduction 

It is widely accepted that providing an appropriate pressure 

reliving mattress is essential for those people who are 



very high risk or who have established pressure ulcer damage. 

The KCI Proficare Mattress Replacement System can 

provide both dynamic alternating and static pressure management 

and is intended to help prevent and manage pressure 

ulcers while optimizing comfort. It consists of 17 individual 

air cells which can be removed during treatment to 

optimize pressure relief, surrounded by a breathable waterproof 

two-way stretch cover. 

Method 

The aim of the clinical evaluation was to examine the effect 

of the KCI Proficare Mattress Replacement System on the 

healing of pressure ulcer damage. Five nursing home residents 

with established pressure damage consented to evaluate 

the Mattress over an eight week period. The wound(s) 

of each resident which were predominantly Grade 3 and 4 

(EPUAP, 2001) were photographed prior to the evaluation 

commencing. The resident’s existing mattress was replaced 

with a KCI Proficare Mattress Replacement System. The 

wounds were photographed on day two and thereafter 

weekly, for eight weeks. Medical and demographic information 

was obtained. 

Results 

The pressure ulcers in all of the residents demonstrated 

healing during the evaluation period, with one resident’s 

ulcer completely closing. One of the residents whose wound 

was making good progress died suddenly during week seven 

of the evaluation. All of the residents reported the mattress 

to be comfortable and staff comments concurred with this 

opinion. None of the mattresses suffered mechanical failure 

during the evaluation period. 

Summary 

This small evaluation would suggest that the KCI Proficare 

Mattress Replacement System can be effective at assisting 

in the healing of severe pressure damage in high-risk subjects. 

Furthermore, all of the residents who used the Mattress 

informally reported the mattress to be comfortable. 

Staff comments were also extremely positive. 

These results are encouraging, although it is unwise to 

draw any firm conclusions from such a small population. A 

larger study may be indicated in order to provide comparative 

evidence. 

References 

EPUAP (2001) Pressure ulcer classification. 

EPUAP Business Office. Wound Healing Unit. 

Department of Dermatology. Churchill Hospital. Oxford. 

www.epuap.org/gltreatment.hmtl 

PORTABLE NMR SPECTROSCOPY OF THE 

SOFT TISSUES: A NORMATIVE STUDY 

Duncan Bain, John Henton, Graham Nicholson and 

Martin Ferguson-Pell 

Centre for Disability Research and Innovation, University 

College London 

Introduction 

Technologies are now emerging to assist in the early identification 

of superficial pressure ulcers 1 . There is still a need 

92 

for diagnosis of pressure ulcers hat originate deeper in the 

tissues. Nuclear magnetic resonance (NMR) provides the 

potential for non-invasive examination of the tissues beneath 

the skin. Parameters relevant to pressure ulcers, such 

as ischaemia, oedema, and inflammatory responses, have 

previously been examined for other purposes using NMR. 

Alikacem et al 2 examined inflammatory responses to encapsulated 

foreign bodies using NMR, and found that certain 

NMR parameters correlated strongly with blood activation 

studies and histology. Klein 3 evaluated the viability of skin 

flaps using magnetic resonance spectroscopy. Richard et al 4 

examined age-related modifications of MRI parameters in 

the skin in vivo, relating the changes to structural deterioration. 

Physico-chemical and morphologic parameters of skin 

layers and subcutaneous tissue in the lymphedematous limb 

have been studied in vivo using magnetic resonance 

imaging 5 . Problems with this approach hitherto have been 

as follows: MRI is an expensive procedure, both in terms of 

capital and consumables. This limits not only its use for 

bulk data-gathering, but also its ultimate application as a 

routine screening tool for pressure ulcers. 

NMR spectroscopy, conversely, is much less expensive, 

but has historically only been suitable for in vitro samples, 

owing to the small size of available chambers. Recently, a 

mobile NMR device similar to a geological bore-hole probe 

has been developed for applications in materials science 6 . 

Using a small, hand-held probe incorporating permanent 

magnets, inhomogeneous polarising and radio-frequency 

magnetic fields are applied to arbitrarily large samples from 

one side. 7 To examine the usefulness of this technology for 

early identification of sub-dermal pressure ulcers, and for 

the characterisation of abnormal properties of soft tissues, 

a normative study was conducted to establish the range of 

values of NMR parameters that occur in normal tissues in 

different subjects, and in different parts of the body. 

Methods 

A hand-held permanent magnet surface coil was used to 

measure NMR parameters in the skin and underlying tissues 

of twenty healthy subjects. Measurements were made 

on the sacrum, buttocks, scapula, forearm, trochanter, and 

heels. T2 was measured at the surface, and at 5mm depth. 

Results 

Inter-subject variations in normal subjects are of lower order 

than intra-subject inter-body-site variations. The NMR 

map of the body may, therefore, be considered relatively 

generalisable for the normal population. T2 at 5mm depth 

was sensitive to body-fat, and correlated with body mass index. 

Earlier work indicates that NMR parameters in incipient 

pressure sores fall outside the range measured in normal 

subjects. 

Summary 

The applicants now propose to conduct an extensive study 

of the NMR parameters associated with pressure ulcers, 

compared with those of normal tissue. This process will 

generate a normative database, document the natural history 

of the pressure ulcer from an entirely unseen perspective, 

and identify possible strategies for prediction, early 

identification, and improved intervention decisions. 


References 

1. Bain D, Ferguson-Pell M, Mcleod A: Skin evaluation 

apparatus. World patent WO0060349 

2. Alikacem N, Strman PW, Marois Y, Jakubiec B, Roy R, 

and Guidoin R. Non-invasive follow-up of tissue 

encapsulation of foreign materials. A magnetic 

resonance imaging and spectroscopy breakthrough. 

ASAIO J 1995 Jul-Sep; 41(3): M617–24. 

3. Klein HW, Gourley IM. Use of magnetic resonance 

spectroscopy in the evaluation of skin flaps. Ann Plast 

Surg Jun; 20(6):547-551 

4. Richard S, Querleux B, Bittoun J, Jolivet O, Idy-Peretti 

I, and de Lacharriere O, Characterisation of the skin 

in vivo by high resolution magnetic resonance 

imaging: water behaviour and age-related effects. 

5. Idy-Peretti I, Bittoun J, Alliot FA, Richard SB, 

Querleux BG, and Cluzan RV. Lymphedematous skin 

and subcutis: in vivo high resolution magnetic 

imaging evaluation. J Invest Dermatol 1998 May; 110(5): 

782–787. 

6. Blumich B, Blumler P, Eidmann G, Guthausen A, 

Haken R, Schmitz U, Saito K, and Zimmer G. The 

NMR-mouse: construction, excitation, and applications. 

Magn Reson Imaging. 1998 Jun–Jul; 16(5–6): 

479–84 

7. Zimmer G, Guthausen A, and Blumich B. Characterization 

of cross-link density in technical elastomers by 

the NMR-MOUSE. Solid State Nucl Magn Reson. 1998 

Sep; 12(2–3): 183–90. 

PRESSURE ULCER PREVENTION IN HOME 

HEALTH CARE – A DESCRIPTIVE STUDY 

Tom Defloor, Maggy Van Den Hel, Mieke Grypdonck, 

Nursing Sciences Ghent University, UZ Blok A, De 

Pintelaan 185, 9000 Gent, Belgium 

Introduction 

Pressure ulcers are a real problem in home health care, 

resulting in a high cost and human suffering. The aim of 

the study was to gain insight in the pressure ulcer prevalence 

in home health care and in the knowledge of nurses 

and their attitudes towards pressure ulcer prevention. 

Method 

Based on the Belgian pressure ulcer guidelines a pressure 

ulcer knowledge test was developed and validated by experts 

using a Delphi procedure. The attitudes towards pressure 

ulcer prevention were studied using a questionnaire. 

The EPUAP minimum data set was used to perform a pressure 

ulcer prevalence study. 

Sample 

All nurses (N = 174) working in a home health care organisation 

in East- and West-Flanders (Belgium) were asked to 

participate in the study and 112 participated; 547 patients 

from nine districts in East-Flanders were included in the 

prevalence study. 

Results 

The overall knowledge on pressure ulcers was low. Home 

health care nurses claimed that they mainly used their own 


experiences to guide their preventive care. However, more 

than 50% of the nurses thought that the introduction of a 

prevention protocol would be useful or very useful. Journals 

are seldom consulted, except for those journals that 

are available in the office. 

The home health care nurses did not use a formal risk 

assessment scale. Their risk assessment was based mainly 

on the mobility and general condition of the patients. 

The home health care nurses could decide independently 

if preventive measures had to be taken and which preventive 

measures. Patient and family were consulted if the 

preventive measures had a major financial impact. The role 

of the family physician was not clear. He/she has a limited 

participation in the decision to start prevention. However, 

he/she was consulted when the preventive care had to be 

changed and that was conceived as a limitation of their care. 

The knowledge on the effectiveness of preventive measures 

was low. Their was also a discrepancy between the preventive 

measures that they thought to be effective and the 

measures they used in their own practice. Preventive measures 

with a limited effect were frequently used, more effective 

measures were seldom used. Financial and feasiblity 

concerns explained only partially this finding. 

The pressure ulcer prevalence was 7.5%; 1.2% of the atrisk 

patients received adequate preventive care. 

Conclusion 

The need of educational programs on pressure ulcer prevention 

and the development of evidence based protocols 

are immanent. It is important to take the attitudes towards 

prevention into account when protocols are developed and 

implemented. 

AN EUROPEAN PUBLIC TENDER FOR 

ANTI-DECUBITUS MATTRESS MATERIAL 

IN AN ACADEMIC HOSPITAL CENTER; 

A CHALLENGING PROCESS 

F. Heule (1,2) , D. van der Eijk (1,2) , Alexander Doeff (3) 

(1) Dept. of Dermatology, (2) Local Pressure Ulcer Advisory 

Panel (PUAP), (3) Dept. of Purchasing, Erasmus Medical 

Center, PO box 2040, Room H-897, 3000 CA, Rotterdam, 

The Netherlands. 

Introduction 

European rules dictate an European Public Tender (EPT) 

procedure for deliverance of goods or services with a value 

of Euro 249,000 and over. For all pressure ulcer preventive 

or curative (p/c) mattress material on a rental basis an average 

sum of Euro 450,000 in Erasmus MC, a 1300 bed hospital, 

is spent annually. Therefore, it was decided to start an 

EPT procedure. 

Material and methods 

The local PUAP and the Department of Purchasing worked 

together to make an overview of needs and wishes regarding 

product type, quality and management aspects. It was 

our goal to select a small gamma of products for a fair price 

from one or two trustful external partners. In three boxes 

low, middle and high-class p/c mattress material was discerned. 

In a matrix model standardised quality criteria were 

summarised, interface pressure measurements being a re- 



search spearhead activity in our center, was a major citerium, 

and linked to a point qualification system. Also for purchasing 

aspects, deliverance estimates and subscription of a basic 

contract were credited with points. 

Results 

After six months the formula were ready. After publication 

of the EPT procedure in the European electronic pathway 

for these announcements, five companies subscribed, all 

of them having a basis in the Netherlands. The offered material 

was unevenly spread over the boxes. Answering of the 

criteria was often inaccurate. In general the material for 

documentation (like brochures) of products was of low 

quality; outdated and partly in a foreign language (English). 

The information on the most important aspect, i.e., 

pressure relief capability was limited and inadequately sustained. 

Pricing was competitive, certainly in view the previous 

package. The total of points has resulted in the choice 

of two (potential) partners for the three boxes. However, 

one of them appeared not to be able to realise the offered 

quality and prices, and dropped out. The second in row 

was then invited and, after further discussions, the deals 

were confirmed. The total new set of p/c mattress material 

will now be introduced in the hospital. 

Summary 

The first EPT in the Netherlands of special mattresses for 

the prevention and treatment of pressure ulcers has been a 

learning experience both for the companies as for the decision-makers 

in the hospital. It was a time consuming and 

nerve tracking process in spite of the preparation work. Key 

words like professionally, teamwork, and fair play are relevant 

in this complex project. An evaluation of this obligatory 

EPT procedure is warranted. Time will show if it is rewarding. 

Reference 

Schofield T. Producing criteria for static mattress tender 

and purchase. J Woundcare 2001; 10(3): 77–9. 

PRESSURE ULCERS IN THE PERIOPERATIVE 

ENVIRONMENT: THE RESEARCH EVIDENCE 

‘… the operating table, [is] where so many so-called “postoperative” 

pressure sores originate’ (Norton, 1967) 

‘theatre tables and trolleys are probably the root case of a large 

proportion of pressure sores in surgical areas’ (Waterlow 1996) 

Eileen M Scott RGN, BA(Hons), MLitt, PhD 

Research and Development Co-ordinator, and Nurse 

Researcher, North Tees and Hartlepool NHS Trust, 

Stockton-on-Tees, TS19 8PE, England, UK 

The above comments illustrate the received wisdom that the 

operating theatre is a high risk area. They are the words of 

prominent British nurses – Doreen Norton and July Waterlow 

– whose views have the authority of the ‘expert’ on pressure 

ulcers. 

This paper, which is based on the author’s doctoral thesis 

(Scott 2000) will provide a review of the existing research 

evidence, from the 1970s to the current day. Key areas are: 

Risk assessment 

94 

Effects of anaesthesia and surgical trauma 

Inequalities of risk 

Duration and intensity of pressure 

The main findings will be summarised and areas where 

further research is needed will be identified. 

References 

Norton D (1967), Preventing lesions of the pressure 

areas, Nursing Mirror (14th July) 341–343. 

Scott E M (2000), Hospital acquired pressure sores in surgical 

patients. Unpublished PhD thesis, University of 

Teesside, UK. 

Waterlow J (1996), Operating table. The root cause of 

many pressure sores? British Journal of Theatre Nursing 6 

(7) 19–21. 

DISABILITY – PRESSURE SORE PREVENTION 

– A MULTIDISCIPLINARY APPROACH 

Margaret Ryan RGN RSCN, Maria Collins, Head of Nursing 

Department, CRC 

Nursing Department, Central Remedial Clinic, Vernon 

Avenue, Clontarf, Dublin 3, Ireland 

Introduction 

The Central Remedial Clinic (CRC) is a national organisation 

for the care, treatment and development of children 

and adults with physical and multiple disabilities. In 2002, 

a nurse-led Pressure Management Committee was formed 

with the remit of developing a multidisciplinary, multifaceted 

approach to pressure ulcer prevention and management. 

Nurse leaders coordinate the services of a multidisciplinary 

team including medical consultancy, seating and 

assistive technology, physiotherapy, occupational therapy, 

dietetics, social work and psychology. 

Objectives 

• The utilisation of all available resources to achieve a 

reduction in the incidence of pressure ulcers. 

• To devise a multidisciplinary approach to pressure 

ulcer prevention. 

• To reduce the personal and economic cost of pressure 

ulcer treatment. 

Methods 

• Nursing assessment of risk factors. 

• Coordination of multidisciplinary team/services, ie, 

utilisation of pressure monitoring system through 

seating/assistive technology. 

• Mobilisation of relevant treatment/services. 

• Implementation of planned and sustained programme 

of action. 

Result 

• An improved quality of life for our clients. 

• A more cost effective use of clinical resources. 

Summary 

Primary indicators of this prospective programme of pressure 

prevention, which is still in its infancy, promise a reduction 

in pressure ulcers through this multidisciplinary 

approach. 


PADS AND PRESSURE: AN INVESTIGATION 

INTO THE EFFECTS OF ABSORBENT 

INCONTINENCE PADS ON PRESSURE 

MANAGEMENT MATTRESSES 

Fader M, Bain D, Cottenden A. 

Continence Technology Group, Departments of Medicine/ 

Medical Physics and Bioengineering; Tissue Viability 

Research Unit, Centre for Disability Research and 

Innovation, University College London, England 

Introduction 

Pressure ulcers and incontinence often co-exist. 1 Urinary 

incontinence has been found to be a significant risk factor 

for pressure ulcers2 and there is a strong association between 

poor mobility and continence problems. 3 Patients 

using pressure management products are therefore also 

likely to be using absorbent pads but the effect that pad 

wearing has on pressure-relieving products is unknown. The 

aim of this study was to determine the effects that absorbent 

pads have, in both dry and wet states, on the pressurerelieving 

properties of standard and pressure management 

mattresses. 

Methods 

An instrumented articulated anthropometric phantom (Patent 

IPC 94928968.0) with simulated soft body ‘tissues’ in 

the gluteal and sacral areas was used as the ‘subject’. The 

soft tissues of the pelvic region are a silicone polymer compound 

with the same mean instantaneous static hardness 

value as the buttock tissues of a cohort of elderly volunteers 

(mean age 68.2 years, SD 3 years) 4 . The silicone compound 

was moulded in a CNC-generated mould representing the 

shape derived from numerical topography data acquired 

by laser scanning the same cohort of volunteers. The phantom 

is fixed on a ceiling-mounted guidance system for positioning 

on different surfaces. The phantom produces 

reproducible pressures (co-efficient of variation around 2%) 

compared to humans and is the method recommended by 

the European Pressure Ulcer Advisory Panel (EPUAP) for 

testing pressure management products. 5 

A commonly used, commercially available absorbent pad 

and pant system for moderate to heavy incontinence was 

selected (Tena Comfort Super, SCA Hygiene Products AB, 

Göteborg, Sweden). This was tested with three different 

mattresses: (A) a standard foam mattress, (B) a visco-elastic 

(VE) foam mattress and (C) a surface-cut VE foam mattress. 

Mattresses (B) and (C) are marketed as pressure management 

mattresses. The phantom was raised and lowered 

onto the three mattresses in three states: naked, wearing a 

dry pad and wearing a wet pad following a standard operating 

protocol. The pressure mapping device Xsensor version 

4 (Xsensor Technology Corporation, Calgary, Canada) 

was used to record the distribution of pressure over the sacral 

and ischial areas of the phantom. Peak pressure was used 

as the primary outcome variable and ten repeats were made 

on each mattress under each condition. 

Results 

The table below shows that presence of an incontinence 

pad between the patient and the support surface raises the 

peak pressure by around 20–25%, a difference which is likely 


to be of clinical importance. Peak pressures frequently occurred 

over areas of pad folds. Additional testing showed 

that pads that were ‘smoothed’ by hand had significantly 

lower peak pressures than ‘unsmoothed’ pads. 

Summary 

This study demonstrated that absorbent pads have a substantial 

adverse effect on the pressure redistribution properties 

of mattresses. Pad folds appear to contribute to this 

effect. Absorbent pad manufacturers should consider engineering 

pads that minimize disruption to pressure management. 

Further examination of continence and pressure 

management products is necessary to establish optimum 

combinations. 

References 

1. Guralnik JM, Harris TB, White LR, Cornoni-Huntley 

JC. Occurrence and predictors of pressure sores in 

the National Health and Nutrition Examination 

survey follow-up. J Am Geriatr Soc 1988 Sep; 36(9): 

807–122. 

2. Spector WD, Fortinsky RH (1998), Pressure ulcer 

prevalence in Ohio nursing homes:clinical and facility 

correlates. J Aging Health 10(1) 62-80. 

3. Sgadari A, Topinkova E, Bjornson J, Bernabei R. 

Urinary incontinence in nursing home residents: a 

cross-national comparison. Age Ageing 1997 Sep; 26 

Suppl 2: 49–54. 

4. Bain DS, Nicholson N, Scales JT. A phantom for the 

Assessment of Patient Support Systems. Med Eng & 

Phys. 21 (1999), 293–301. 

5. European Pressure Ulcer Advisory Panel, Working 

Group 2, Guidelines for the measurement and 

presentation of interface pressure data on support 

surfaces, January 2002. 

NOVARTIS HEALING SOLUTIONS – A TEAM 

APPROACH FOR PRESSURE ULCER WOUND 

CARE 

Posthauer, Mary Ellen, RD, LD, CD, CEO, M.E.P., Healthcare 

Dietary Services, Inc., Evansville, IN; Myer, Anne H., PT, 

GCS, CWS, Saddleback Coordinated Home Care, Laguna 

Hills, CA; Sussman, Carrie, PT, President, Sussman 

Physical Therapy, Inc, and Wound Care Management 

Services, Torrance, CA; Aquino, Maria Paz, RN, BSN, ET, 

Clinical Consultant, Kinetic Concepts Inc., Germantown, 

MD; Baronoski, Sharon, MSN, RN, CWOCN, Joliet, IL; 

Lyder, Courtney H., ND, GNP, FAAN, Associate Professor and 

Director Adult Family, Gerontological and Women’s Health, 

Director, Program for the Advancement of Chronic Wound 

Care, Yale University School of Nursing, New Haven, CT; 

Thomas, David R., M.D., Professor, Saint Louis University 

School of Medicine, Division of Geriatric Medicine, St. 

Louis, MO. 

Objectives 

Bring together a team of multidisciplinary pressure ulcer 

subject matter experts to develop and prepare a evidencebased 

program to aide long term care clinicians in pressure 

ulcer prevention and treatment. 

Development of a practical educational guide for long- 



term care built upon and supplementary to previously published 

materials. 

Facilitate the implementation of quality care measures 

for the prevention and treatment of pressure ulcers in long 

term care facilities. 

Introduction / Problem 

Pressure ulcers represent a complex clinical problem for 

which no ‘gold standard’ of prevention or treatment has 

been established. For the elderly, pressure ulcers can have 

serious consequences that may include lifestyle limitations, 

reduced self-esteem, altered body image, pain, delay in rehabilitation, 

and increased morbidity and mortality. 

Preventing skin breakdown and supporting the healing 

of existing pressure ulcers is a problem for caregivers of 

the geriatric population in long term care facilities. 

Methodology 

Constructed on evidence-based materials, a multidisciplinary 

panel of pressure ulcer subject matter experts developed 

an educational guide to implement a team approach 

of best practices for pressure ulcer prevention and 

treatment in the long term care setting. 

Results 

A set of fourteen overlapping decision trees for medical, 

nursing, nutrition, and physical therapy management were 

designed and produced. The decision trees provide a systematic 

approach to clinical problem solving including caveats. 

Each decision tree elaborates on its components and 

develops each discipline’s contribution to overall care. 

Conclusion 

Fourteen overlapping decision trees form the package 

known as The Healing Solutions Program: a team approach 

for pressure ulcer wound care. The Healing Solutions program 

is scheduled to be launched in February of 2003. The 

goal is to have 25 national and regional facilities utilizing 

the program by the end of 2003. Plans include tracking 

outcomes to evaluate if and how the program changes clinical 

practice in long-term care facilities. 

EDUCATIONAL PROGRAMME FOR 

ASSISTANT NURSES ACCORDING TO 

EPUAP GUIDELINES 

Anna-Britta Tallberg R.N., Agneta Bergsten R.N. 

Wound Healing Centre, Department of Surgery, University 

Hospital, Uppsala, Sweden. 

Introduction 

An educational programme for registered nurses was developed 

and implemented in 1998 and repeated in 2001. 

These pressure ulcer nurses have been active in pressure 

ulcer prevention in their own units. Since pressure ulcer 

prevention is a multidisciplinary teamwork it was important 

to include assistant nurses in this work. 

Objectives 

To conduct an educational programme for assistant nurses 

working in different units in the university hospital, in nursing 

homes and home care units. 

96 

Method 

The educational programme was adjusted to assistant nurses 

and based on guidelines issued by the European Pressure 

Ulcer Advisory Panel. The course consisted of twelve hours 

of theory (three afternoons) and practical tasks. For example, 

the participants should perform an inventory of routines 

for pressure ulcer prevention and dressings in their 

own units. Two nurses from the wound healing centre were 

course leaders together with two pressure ulcer nurses. 

Result 

The educational programme was held twice with thirty participants 

in each course. An evaluation showed that the participants 

were very satisfied. 

Conclusion 

The educational programme was successful. The number 

of candidates who applied to the courses was twice as many 

as there were places. 

INVESTIGATION OF THE MINIMUM SPATIAL 

RESOLUTION REQUIRED BY PRESSURE 

MAPPING SYSTEMS FOR SEATED PATIENTS 

Nicholson G, Elhusseiny A, Bain D, and Ferguson-Pell M. 

Centre for Disability Research and Innovation, University 

College London and ASPIRE, Brockley Hill, Stanmore 

Middlesex. HA7 4LP. g.nicholson@ucl.ac.uk 

Introduction 

Wheelchair users, particularly those with spinal injuries, are 

at significant risk of developing pressure sores. In order to 

assist clinicians in the evaluation and selection of suitable 

cushions the mapping of pressure distribution at the buttock/cushion 

interface is being increasingly used. The 

greater the number of sensors across the interface, or spatial 

resolution, the greater the chance of identifying changes 

in pressure, giving a more realistic representation of a person’s 

actual pressure distribution. Commercial pressure 

mapping systems vary greatly in the spatial resolution, and 

in order to make up for a lower spatial resolution manufacturers 

use interpolation. The aim of this study was to assess 

the influence of sensor spatial resolution on measured pressure 

values at a seated interface and a therapists’ ability to 

make subjective judgements from them. 

Methods 

Pressure distributions from ten spinal cord injured patients 

and ten able-bodied subjects were collected using a highresolution 

pressure mapping system (Tekscan, Boston, MA). 

The spatial resolution of these pressure distributions was 

degraded mathematically, and cubic spline interpolation 

applied to the degraded pressure distributions to give three 

pseudo levels of spatial resolution; Resolution 1, 40 x 40 

sensing elements (7 mm diameter) with 10mm spacing between 

their centres; Resolution 2, 20 x 20 sensing elements 

(7 mm diameter) with 20mm spacing between their centres 

and interpolated to 40 x 40; Resolution 3, 10 x 10 sensing 

elements (7 mm diameter) with 30mm spacing between 

their centres and interpolated to 40 x 40. The original and 

degraded–interpolated pressure distributions were scored 

by three occupational therapists and two rehabilitation en- 


gineers in terms of obliquity, rotation, pelvic tilt and localisation 

of pressure. The pressure distributions were quantified 

in terms of peak pressure, average pressure, peak pressure 

index, localisation of pressure, and index gradient at 

peak pressure. 

Results 

Sensor repeatability was 2–3% between 50–200 mmHg, linearity 

2–5%, creep


They were originally used for characterising foam slabs and 

cushions that may be used by many people. They do not 

take into account conformability of the cushion nor the 

custom fit to an individual. The “fatigue” test produced 

only small changes in the cushions, raising the question 

whether they were really fatigued at all. Had more cushions 

of a single type been tested for inter-cushion reproducibility 

such differences may no longer have been of significance. 

A EXAMINATION OF THE EFFICACY OF THE 

CONTRACTURAL PAD FOR PRESSURE ULCER 

Makiko Tanaka, Miki Haruma, Maki Mimura and Kouji 

Kajiwara 

Yamaguchi Prefectural University School of Nursing, 

Yamaguchi, Japan. Molten Corporation, Hiroshima, Japan 

Introduction 

Through the questionnaire administered to 404 nurses in 

Japan, it was made clear that many nurses experience difficulty 

with positioning of patients with pressure ulcer. It was 

particularly noteworthy that while 84% of the nurses felt 

the necessity of the positioning as a care for contractural 

patients, they did not possess any effective methods. A pad 

for contractural patients was therefore devised; its effects 

are described in this paper. 

Method of Measurement 

Because it is not possible to generalize contracture, the 

upper body muscular contracture (the shoulder’s incycloduction, 

adduction, and upper arm pronation) often seen 

in clinical settings, was used as the standard contractural 

position. The contractural pad was made of perforated 

urethane foam with the cover having a perforated honeycomb 

structure. The body pressure dispersion effect and 

the humidity of this pad were examined when the pad was 

placed under the arm and when it was not. 

Conditions of Measurement 

The contractural standard position was simulationally assumed. 

Then the body pressure sensor and the humidity 

sensor were placed and a measurement for each was taken 

five times with one subject (female, BMI 19.0). As for the 

humidity, a measurement was taken after over one hour of 

continuous usage. 

Results 

The average body pressure when the contracture pad was 

not used, was 51mmHg, while the average when it was used 

was 28.6 mmHg, indicating a lower body pressure when the 

contractural pad was in use. As for the humidity, an examination 

of an approximate linear line showing the humidity 

change showed a larger slope when the pad was not used, 

indicating a marked increase of humidity. The humidity one 

hour after the beginning of the measurement was 71% when 

the pad was not used and 30.7% when it was used. 

Summary 

It may be concluded that the contractural pad under discussion 

was effective as a cushioning device to the body pressure 

and humidity. 

98 

STUDY OF FIVE BED MATTRESSES USING 

PRESSURE MAPPING AT 500-BED LONG-TERM 

CARE FACILITY 

Vern C. Taylor, P.T. Physical Therapist, Verg Inc., Winnipeg, 

Manitoba, Canada 

Beth Kondratuk, R.N., B.N., M.S.A, Clinical Nurse Specialist, 

Deer Lodge Centre, Winnipeg, Manitoba, Canada 

Introduction 

In North America, over 1.8 Million people develop ulcers 

annually, 1 which cost up to $1.3 Billion/year. 2 Prevalence 

is estimated at 11% in skilled-care and nursing homes, 10% 

in acute care, and 4.4% in home care. 3,4,5 Causes of these 

ulcers is multifactorial and include lowered sensory perception, 

immobility, incontinence/moisture, altered level of 

consciousness, poor circulation, severity of disease, and poor 

nutritional status. 6,7,8,4,9 Wound Care is expensive. The cost 

of treating one ulcer is reported to be from $5,000 to $60,000 

depending on stage of ulcer and patient condition. 10,11,12,13 

Long Term Care facilities have the challenge of caring for 

the chronically ill on a continuing basis. This group of patients 

is subject to pressure ulcers associated with their disabling 

condition. Nursing at these facilities must provide 

preventative management and heal existing wounds within 

a very limited budget. 

Methods 

This study assesses five bed mattress surfaces that range in 

cost from least expensive to the highest affordable price 

within the institutional budget. A multi-layered single case 

study design was used with a healthy 81-year-old volunteer 

that closely matched the average (age, gender, weight) of 

the patient population. The volunteer was positioned in four 

standard nursing positions used routinely in care at the facility. 

A Standard Hospital mattress was used first and last for 

each test series to provide a control. Multiple pressure maps 

were taken of each position, using a calibrated Force Sensing 

Array (FSA) pressure mapping system.[*] Results were 

collected and pressure distribution was compared for each 

position and all mattress surfaces using three methods: 

Sensor Count: defined as total number of sensors reading 

above a minimum threshold. This measure indicates how 

much contact is occurring with the patient in each position 

and each mattress type. This would indicate the amount of 

envelopment for each bed mattress. 

Peak Pelvic Pressure Row: the cross-sectional row of highest 

pressures identified at the pelvis region in each position 

for each surface was graphed and compared. This allowed 

the different surfaces to be compared on a single graph for 

the pressure row at the highest pressure point through the 

pelvis. 

Pressure Map Comparisons: the complete pressure map 

images were blinded to the type of surface and the readings 

for each nursing position were presented to the caregiving 

nurses for ranking (best to worst) in their judgment. 

The nurses were also asked to rate the comparative value of 

the pressure map based on the nurse’s perception of usefulness 

to their patient using a 0–5 scale. Five skilled wound 

care nurses and five regular duty nurses were used and these 

results were then graphed separately and together for comparison. 


Results 

Presented results demonstrate: Sensor Count, the most 

objective measure, showed Standard hospital mattress to 

be poorest in all positions but did not demonstrate much 

differentiation for other surfaces. Peak Pelvic Pressure Row 

graphing clearly demonstrated relative differences well 

which allowed good comparison of different surfaces for 

each position. Pressure Map comparisons by nursing staff 

showed good correlation amongst assessors and allowed for 

ranking and valuation of the surfaces under consideration. 

Summary 

Using a standardized assessment with a healthy volunteer, 

representative of patient population, with three review 

methods derived from pressure mapping proved very useful 

in understanding the relative value of the bed mattress 

surfaces under consideration by nursing. From this assessment 

a recommendation was compiled for mattress purchases 

for prevention and management of ulcers in the facility. 

It is hoped that this evidence based recommendation 

forwarded to administration for future mattress purchases 

would aid nursing to provide improved quality of care within 

a limited budget including prevention and healing of Pressure 

Ulcers in this Long Term Care Facility. 

[*]Verg Inc. manufactures the FSA Pressure Mapping System 

used in this study. The second author is a co-owner of 

the company and provided the technical equipment and 

assistance for this study. 

References 

1. POV Inc.(1998), Long term care: Evolving business 

opportunities and threats. Cedar Grove, NJ. 

2. Miller, H. and Delozier, J.(1994) Cost implications of 

pressure ulcer treatment guideline (pp. 1–17). 

Columbia, MD: Center for Health Policy Studies. 

CNo. 282–91–0070. Sponsored by HCP&R 

3. Barczak, C.A. et al(1997), Fourth National Pressure 

Ulcer Prevalence Survey. Advances in Wound Care, 

10(4), 18–26. 

4. Brandeis, G.H., Berlowitz, D.R., Hossain, M., and 

Morris, J.N. (1995). Pressure ulcers: The minimum 

data set and the resident assessment protocol. 

Advances in Wound Care 8(6), 18–25 

5. Hallet, A.(1996), Managing pressure sores in the 

community. Journal of Wound Care 5(3), 105–107. 

References 6–13 were provided at the conference. 

STUDY ON PRESSURE ULCERS (PU), THEIR 

LOCATIONS AND PROTECTION MEASURES 

ON THREE INTENSIVE CARE UNITS OF THE 

ACADEMIC MEDICAL CENTER IN 

AMSTERDAM 

J.A. Tutuarima 1 , M.J. Lubbers 2 , J. Vorstermans 3 

1. Nurse researcher, Department of Neurosciences, 

2. Surgeon intensivist, Department of Surgery, 

3. Intensive care nurse, The Academic Medical Center, 

University of Amsterdam in Amsterdam, The Netherlands 

Introduction 

On the Intensive care units PU are a serious problem. High 


percentage is usual. 1 The Dutch Institute for Healthcare 

Improvement (CBO) in Utrecht started a multi-center 

project to improve risk assessment, prevention, diagnosis 

and treatment of existing pressure ulcers. This study is part 

of the CBO project. The objective of this study is to determine 

the prevalence of pressure ulcers (PU) and of post 

surgical onset of PU as well as factors associated with PU 

and to assess the specific protection measures. 

Methods 

We designed an observational cohort study on 130 consecutively 

admitted patients in three adult intensive care units 

of a Dutch university hospital. The primary nurse daily inspected 

the presence of PU and assessed the protection 

measures with regard to prevention and healing of PU over 

a period of two months. 

Main results 

Of the patients 31% suffered from hospital acquired PU. 

Sacrum, ears and heels were most involved (15, 12 and 12% 

respectively), buttocks, mouth and back were affected in 5, 

4 and 4% respectively. All other nine locations were less 

involved. Post surgical assessment showed PU of the lip and 

fingers in one patient each, of the back of head in two cases, 

of the nose and mouth in three patients each, of the buttocks 

in five cases, and of the sacrum in nine patients. Cross 

tabulation on PU showed no association with gender age, 

post surgery and Apache II. All patients are positioned on 

active pressure relief mattresses. Extra protection measures 

were practised to 80% of the patients. Protection of heels 

and ears each to 60% of the patients, multiple turning position 

and protection of the skin to 43 and 38% respectively. 

Summary 

This observational study showed evidence based figures of 

PU and detailed locations and protection measures of an 

highly risk population of patients for PU in an acute care 

setting. 

Reference 

1. Bours GJ, De Laat E, Halfens RJ, Lubbers. M. Prevalence, 

risk factors and prevention of pressure ulcers in 

Dutch intensive care units. Results of a cross-sectional 

survey. Intensive Care Med. 2001 Oct;27(10):1599–1605. 

MEASURING THE PRESSURE AT ‘THICKENED 

EDGES’ AND ‘NORMAL EDGES’ OF A WOUND 

Mayumi Okuwa 1 , Hiromi Sanada 1 , Junko Sugama 1 , 

Chizuko Konya 1 , Atsuko Kitagawa 1 , Yumiko Fujimoto 2 and 

Nao Tamai 3 

1. School of Health Sciences, Faculty of medicine, Kanazawa 

University, Japan. 2. Kobe City General Hospital, 3. St 

Luke’s International Hospital. 

Introduction 

The 30-degree lateral and 30-degree head-elevated positions 

are widely used in a clinical setting for patients with pressure 

ulcers to relieve the localized pressure on bony-prominent 

areas. A result of this positioning sometimes causes 

the perimeter regions of the pressure ulcer to thicken. This 

phenomenon is believed to be caused by increased pres- 



sured on the perimeter of the wound. However, a new affixed 

sensor (by DENSO Ltd.) was developed to quantitatively 

measure the localized pressure around a wound. The 

purpose of this study was to use this device to measure the 

pressure on this thickened perimeter region and compare 

it with other local regions of a wound. 

Methods 

SENSOR SPECIFICATIONS 

Pad Material: 3 Polyethylene naphthalate (waterproof) 

sensor pads 

Pad Dimensions: diameter x thickness (5 mm x 0.3 mm) 

Recording Interval: 0.16 sec. (simultaneous recording of 

all three sensors) The reliability and validity of the sensor 

were confirmed. 

SUBJECTS 

The informed consent was received by the five bedfast patients 

(mean age 78.6) with pressure ulcer who participated 

in this study. In the perimeter of each wound thickened 

parts and normal (thickening-free) parts existed. The 

wounds were located at sacrum or coccyx. 

CONDITIONS AND MEASURING PROCEDURE 

The pressure of specific areas around the wound region 

for each patient was measured at thirty-minute intervals 

with the patients lying in both the 30° lateral and 30° headelevated 

positions. We measured the pressure of visibly thickened 

edges and normal edges of each wound. 

ANALYSIS 

We categorized our data into two groups. One representing 

‘thickened edges’ and the other representing ‘normal 

edges’. We then compared both the maximum pressure values 

as well as the average pressure values for each group by 

using the Wilcoxon test. 

Results 

Both the 30-degree lateral position and 30-degree head-elevated 

position showed that the maximum pressure as well 

as the average pressure of the ‘thickened edges’ was significantly 

greater than that of the ‘normal edges’. 

Conclusion 

Based on our results, we found that the pressure at the ‘thickened 

edges’ was greater than at the ‘normal edges’. Furthermore, 

we found that positioning patients in the 30° lateral 

or 30° head-elevated position may not decrease the local 

pressure of these areas. We need future research to confirm 

a relationship between the positioning and the physical 

characteristics in Japanese elderly. 

CLASSIFICATION OF HEALING PROCESS 

PATTERNS OF PRESSURE ULCERS WITH 

UNDERMINING FOR JAPANESE ELDERLY 

Chizuko Konya, Hiromi Sanada, Junko Sugama, Mayumi 

Okuwa and Atsuko Kitagawa 

School of Health Sciences, Faculty of Medicine, Kanazawa 

University, Japan 

Introduction 

Since there has been no reported research on the healing 

process for the conservative treatment of pressure ulcers 

100 

with undermining, the healing process of this type of pressure 

ulcer is unknown. The purpose of this study was to 

categorize pressure ulcers with undermining into patterns 

and to examine the healing process of each pattern. We 

also attempted to determine what type of nursing care and 

physical factors influenced the healing process of each pattern. 

Method 

This study involved 69 elderly patients (65 years old, or 

older) with Stage III or IV pressure ulcers. We examined a 

total of 79 pressure ulcers. Informed consent was obtained 

from all patients. Photographs of the pressure ulcers were 

taken and hand-sketched on a weekly basis. Based on these 

sketches, we described the healing process of each pressure 

ulcer. We then inductively classified and statistically 

compared the following criteria of each healing process 

pattern: the healing period, wound surface area, type of 

nursing care and various physical factors. 

Results 

Of the 79 pressure ulcers, 57% were undermining. Based 

on the pressure ulcer healing process (undermining and 

epithelialization), ten healing patterns were inductively 

categorized. We discovered two phenomena: 1) When undermining 

was present with no necrotic tissue, the undermining 

spread inversely to wound contraction, a phenomenon 

we termed as ‘Undermining-spread-partial wound 

margin’, (hereafter referred to as ‘Us’). 2) Some epithelialized 

wounds closed only by contraction, a phenomenon 

we termed as ‘Epithelialization-contraction’, (hereafter referred 

to as ‘Ec’).Our results show the wound-healing period 

for general epithelialization was longer than for ‘Ec’ 

type wounds (p = 0.008). The physical factors that influenced 

undermining were external bony prominence (p = 

0.003), urinary incontinence (p = 0.011), contracture (p = 

0.023), and loose skin in the buttock area (p = 0.020). Similarly, 

the physical factors that influenced ‘Ec’ were external 

bony prominence (p = 0.0016), urinary incontinence (p = 

0.001), shear (p = 0.032), and contracture (p = 0.025). 

Summary 

Based on the healing process for Stage III or IV pressure 

ulcers, we discovered the phenomenon referred to as ‘Us’ 

and ‘Ec’ and inductively categorized ten healing process 

patterns. The results show these categories of undermining 

and ‘Ec’ to have a significant relationship with external 

bony prominence, urinary incontinence and contracture. 

The remaining Poster Abstracts from Tampere 

will appear in the next issue 


epuap News 


from Italy 

DEVELOPMENT OF CONSENSUS UPON THE DESCRIPTION OF 

PATIENT SUPPORT SURFACES WITHIN ITALY 

SUPPORT surfaces; be they beds, mattresses or cushions, 

play an important role within pressure ulcer 

prevention and management. However, the current 

lack of clarity in our definitions of these devices hampers 

our ability to compare and contrast different surfaces; for 

example when should surfaces be termed dynamic or static; 

pressure-relieving, reducing or redistributing? The lack of 

common definitions also impacts upon staff training in the 

correct use of such aids and prevents national (and international) 

agreement upon the role of support surfaces 

within pressure ulcer management. At a national level conflicting 

and confusing classifications may hamper reimbursement 

while posing challenges when developing product 

specifications within competitive tenders. These issues 

prompted AISLeC to initiate a consensus development 

Figure 1. The consensus development group at Livigno, July 2003. 

project to improve the description of support surfaces with 

the ultimate goal of improving the quality of pressure ulcer 

prevention and management in Italy. The fruits of this consensus 

upon terminology and support surface evaluation 

would be used to assist the national Health Ministry and 

regional bodies to update their ‘Prosthesis and Devices Tariff 

Nomenclature’ to provide common descriptions of devices 

so aiding tender development and staff training in the use 

of such interventions. 

The consensus process was designed to represent a wide 

multi-professional perspective with representatives drawn 

from nursing, medicine and biomedical engineering. The 

group were tasked to develop a common terminology to 

describe support surfaces and to review existing evidence 

upon their effectiveness. Beyond the review process a se- 



Figure 2. The discussions went on well into the evening … 

ries of meetings to review technical issues with members of 

the Health Ministry and international experts were also 

planned. 

The consensus group met in Livigno in the north of 

Italy in mid July 2003 with two key objectives; to review existing 

national and international guidelines on support surface 

use and to discuss, and refine, the aims of the project 

with international experts. A series of guidelines were translated 

into Italian and addressed within work groups – over 

the 40 hours of the consensus meeting the work groups 

reviewed translated versions of the EPUAP pressure ulcer 

guidelines, the US AHCPR guidelines along with pressure 

ulcer guidelines and consensus statements from Australia, 

Belgium, Canada, France, Singapore, the UK and the USA. 

The work of the Cochrane beds and mattresses review group 

was also considered by the work groups. 

The detailed review conducted by the working groups 

was complemented by presentations and comments from a 

number of national and international experts including Dan 

Bader (UK), Joe Barbenel (UK), Andrea Bellingeri (Italy), 

Aldo Calosso (Italy), Michael Clark (UK), Carol Dealey 

(UK), Ornella Forma (Italy) and Andrea Nelson (UK). 

Following this initial meeting the process will move to 

the AISLeC web-site: where a private forum 

will allow the consensus development group to work together 

upon the development of the final text. Using the 

web-site will reduce the need for frequent meetings and so 

accelerate the development of the consensus statement. The 

goal is to present the consensus statement during a scien- 

102 

tific meeting with Health Ministry and Court for the Citizens’ 

Rights representation. This meeting will take place 

between 28 April and 1 May 2004 at Lake Garda during the 

III° AISLeC Meeting celebrating the first ten years of the 

Association. Acceptance of the consensus statement after 

the April meeting will begin to ensure common dialogue 

between the government, the clinical and scientific communities 

and product manufacturers. Such dialogue can 

only serve to improve the quality of this important aspect 

of pressure ulcer prevention and management. Both the 

consensus meeting and the presentation of the consensus 

report (28 and 29 April respectively) will be translated into 

English. 

AISLeC would welcome collaboration with EPUAP 

members who have been involved with similar initiatives to 

standardise the definition and evaluation of support surfaces. 

Through such collaboration we should seek to achieve 

general harmonisation of product descriptions and evaluation 

methods across the European Community and wider. 

If you would like to collaborate please contact us at: 

segreteria@aislec.it or abellingeri@venus.it 

This document was prepared by the AISLeC Council – Alberto 

Apostoli, Alex Bacchilega, Marisa Bergognoni, Andrea 

Bellingeri, Sergio Bonelli (past member of the Council), Aldo 

Calosso, Pierluigi Deriu, Ornella Forma, Battistino Paggi (past 

member of the Council), Cristina Patriarca, Roberto Polignano 

with support from Massimo Fornaciari, Raffaele Attolini, 

Claudio Solinas. 



Your abstract should be received by the WUWHS Secretariat (8, rue Tronchet, 75008 PARIS, FRANCE 

E-mail: mbia@wanadoo.fr) by 1 February 2004. Authors will be informed of the Scientific Committee’s 

decision before 15 April 2004. 

104 

C A L L F O R A B S T R A C T S 

The Poster session will be organized in the following categories. Check the category most related to your abstract. 

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Please indicate your choice: Poster ❑ Oral Communication ❑ No preference ❑ 

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ABSTRACT INSTRUCTIONS 

1. The abstract should be sent first by e-mail (mbia@wanadoo.fr) 

or downloaded on the web-site: mfgroupe.com, if neither of 

these two ways are possible for you, you can send it by post/mail 

(on a disk or CD rom) to the Meeting Secretariat at the address 

above, or by fax to: +33 1 40 07 10 94. 

2. The abstract must be written in Word format (95 or higher). 

3. Abstracts must be submitted in English or French. 

4. The entire abstract must be contained within the format of one 

abstract. The text to be contained within the area of this blue 

box: height 17cm (6.70 inches) and width 11.3cm (4.45 inches). 

5. The abstract must be written single-spaced, using Arial 10 point 

font, and must be fully justified. DO NOT use a smaller font, as 

the abstract will later be reduced to 70% of the size for printing 

in the abstract book. 

6. The abstract title (2 lines maximum) should clearly define the 

content of the paper. In the title use all CAPITALS bold letters 

and no abbreviations. Do not centre, start at the left margin. 

7. Type the author’s initials followed by family name, then background 

(MD, PhD, RN, Pod, Phys Ther) followed by the other 

authors’ names (maximum 5), then the affiliations’ name and 

address of the institution, and e-mail of the presenting author. 

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purposes. 

9. Structure the abstract following IMReD (Introduction, Methods, 

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10.In case of support by a grant, please indicate the source of 

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14.Indicate your choice (poster or oral communication, or no 

preference). 


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106 

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Tel: +31 79 353 9673, Fax: +31 79 353 9730 Maaike.dejager@nutricia.nl 

Mr Germain de Keyser, Kapucijnenvoer 35, 3000 Leuven, Belgium 

Tel: 00 32 1633 2211, 00 32 1922 8349 germain.dekeyser@pandora.be 

Dr Erik de Laat, University Medical Centre Nijmegen, 111 Staf Zorg, PO Box 9101, 

6500 HB Nijmegen, The Netherlands Tel: +31 24 361 6560, 

Fax: +31 24 354 1456 e.delaat@zorg.azn.nl 

Mr Fredrik Delas, Bryggenveien 42, 1747 Skjeberg, Norway 

Tel: +47 930 22 712, Fax: +47 69 33 6606 fd@alurehab.com 

Mr Dirk De Wolf, Prinsenmeers 9, Dendermonde, B–9200 Belgium. 

Tel: +31 52 21 5872 dirk.de.wolf@pi.be 

Miss Meike Dewin, Academisch Ziekenhuis, Directir Vorpleging, Laarbeecklaan 

101, 1090 Brussels, Belgium. Tel: +31 2 477 5577, Fax: +31 2 477 5593 

dirndwnm@azwb.ac.be 

Mr Peter Diesing, Buchbinder Weg 55, 12355 Berlin, Germany 

Tel: +49 30 664 61709, Fax: +49 30 664 61708 peter.diesing@gmx.de 

Mrs Jeannie Donnelly, 6 Mount Royal, Bangor, Co. Down, BT12 6BA, Northern 

Ireland Tel: +44 (0)28 914 68875 jeannie.donnelly@royalhospitals.n-i.nhs.uk 

Ms Valerie Dowley, Practice Development Specialist, Pegasus Limited, Waterberry 

Drive, Waterlooville, Hants, PO7 7XX, England 

Dr Inge Duimel-Peeters, Wirixstraat 22, Tongeren, 3700 Belgium 

Tel: +31 43 388 1557, Fax: +31 43 388 4162 i.duimel@xw.unimaas.nl 

Dr Sonia Dumit-Minkel, 1231 E. Donges Crt, Bayside, Wisconsin 53217, USA 

Tel: (and Fax:) 001 414 228 0101 duminkel@yahoo.com 

Mrs Cheryl Dunford, School of Nursing and Midwifery, Nightingale Building, 

University Road, Highfield, Southampton, SO17 1BJ, England 

Mrs Jane Edwards, 17 Windrush Way, Abingdon, Oxon, OX14 3SX, England. 

Tel: 01865 227312 (work) Fax: 01865 742348 jane.l.edwards@noc.anglox.nhs.uk 

Mrs Lynfa Edwards, 135 Kenyngton Drive, Sunbury, Middlesex, TW16 7RU, 

England. Tel: 01932 789022 

Ms Jacqui Elst, Weide 93, 5103 HT Dongen, The Netherlands 

jacam.elst@wanadoo.nl 

Mrs Wendy Eve, Saiyang, 30 Torton Hill Rd, Arundel, West Sussex, BN18 9HL, 

England Tel: 01243 623661, Fax: 01243 623664 wendyeve@u.genie.co.uk 

Mrs Leone Ewings, Tissue Viability CNS, Nurse Practice Development Unit, 

Beaumont Hospital, Beaumont, Dublin 9, Ireland. Tel: +353 1 809 2533 

leone.ewings@beaumont.ie 

Ms Caterina Falce, 109 Barnet Road, Potters Bar, Herts, EN6 2RN, England 

Tel: +44 (0)1707 859153, Fax: +44 (0)1707 664889 caterinafalce@yahoo.co.uk 

Carlos Ferrer, Smith & Nephew SA, Fructuos Gelabert 2 y 4, 08970 Sant Juan 

Despi, Barcelona, Spain Tel: +34 93 373 7301, Fax: +34 93 373 7453 

Ms Johanna Feuchtinger, St-Agatha-Weg 5, 79108 Freiburg, Germany 

Tel: +49 7665 938093 Fax: +49 7612 706153 johanna.feuchtinger@gmx.de 

Dr Rosy Fittipaldi, Via Ticinello No. 34, Pavia, 27100 Italy 

Tel: +39 333 9452041 rosi.fittipaldi@libero.it 

Ms Cynthia Fleck, The ROHO Group, 100 North Florida Avenue, Belleville, 

Illinois, 62221, USA Tel: +618 277 9173, Fax: +618 277 9561 

cynthiaf@therohogroup.com 

Mrs Jacqui Fletcher, University of Hertfordshire, Hatfield Campus, College Lane, 

Hatfield, Herts, AL10 9AB, England Tel: +44 (0)1707 285266, 

(home: 01462 850495), Fax: +44 (0)1707 284954 j.fletcher@herts.ac.uk 

Mr Håkan Freijd, MedTec Nordic AB, Vinbarsvagen 14, S–734 31 Hallstahammar, 

Sweden. Tel: +46 220 126 23, Fax: +46 220 126 23 medtecnordic@netscape.net 

Mr John Furness, Vital Base AS, Myravegen 2, Hareid, NO–6060, Norway 

Tel: +47 700 95959, Fax: +47 700 95951 john@vitalbase.no 

Ms Katia Furtado, Rua Viturino Nemesio, No.2–7 Esquerdo, 1750-307 Lisbon, 

Portugal. Tel: +351 21 758 8288, Fax: +351 21 313 36434 Kaxfurtado@clix.pt 

Mr Lucas Garabet, GerroMed GmbH, Fangdieckstra 75B, Hamburg 22547, 

Germany. Tel: +49 40 547 3030, Fax: +49 40 547 30331 GarabetL@Gerromed.de 

Ms Tracy Gardner, Professional Development Specialist, Pegasus Limited, 

Waterberry Drive, Waterlooville, Hants, PO7 7XX, England Tel: 02392 784200 

EPUAP MEMBERS 

Prof Stefano Gasperini, Via V Maroso, 50, c/o Bristol Myers Squibb, Div. ConvaTec, 

Roma 00142, Italy. Tel: +39 6 50 396378 stefano.gasperini@bms.com 

Mrs Pauline Gatto. 28 Spencer Avenue, Palmers Green, London, N13 4TR, 

England Tel: +44 (0)20 8340 5215 pauline.gatto@haringey.nhs.uk 

Kjetil Gausel, Dreierhagen 21, Sandnes, 4321 Norway 

Tel: +47 9 805 1111, Fax: +47 5 158 1889, kg@alurehab.com 

Mr Krzysztof Gebhardt, PUPT, Room 0.195, Ground Floor, Lanesborough Wing, 

St George’s Hospital, Blackshaw Road, London, SW5 0AH, England. 

Tel: +44 (0)20 8725 2230, Fax: +44 (0)20 8725 1071 

chris.gebhardt@stgeorges.nhs.uk 

Mrs Elaine Gibson, 21 St Mary’s Green, Kennington, Ashford, Kent, TN24 9HP, 

England. Tel: 01233 626837 gibse@btinternet.com 

Ms Marguerite Gordon, 7 Hampstead Park, The Rise, Glasnevin, Dublin 9, Ireland. 

Tel: +353 1 836 0875, Fax: +353 1 848 7821 

Dr Davina Goswell, 1733 Elm Drive, Kent, 44240 Ohio, USA 

Tel: 001 330 672 3777, Fax: 001 330 672 2433 dgoswell@kent.edu 

Dr Allison Graham, 75 Mellstock Road, Aylesbury, Bucks, HP21 7NX, England 

Tel: 01296 315851, Fax: 01296 315867 

Dr Jeffrey Graham, Dept of Health, Room LG24, Wellington House, Walterloo 

Road, London, SE1 8UG, England Tel: 020 7972 4710, Fax: 020 7972 4405 

Mr Mark Green, 1 Greenwood Avenue, Horwich, BL6 6FA, UK. 

Dr Laszlo Gulacsi, Bem ter 8, H–4026 Debrecent, Hungary. 

Mrs Lena Gunningberg, Department of Nursing Research and Development, 

University Hospital, 75185 Uppsala, Sweden. Tel: +46 18 611 3194, 

Fax: +46 18 611 3025 lena.gunningberg@adm.uas.lul.se 

Dr Jeen RE Haalboom, Dept. of Internal Medicine, University Hospital, 

Heidelberglaan 100, Utrecht 3508, The Netherlands. 

Tel: 00 31 30 250 6214, Fax: 00 31 30 253 9060 

Dr Satsue Hagisawa, Nagoya City University, School of Nursing, Kawasumi 1, 

Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. Tel: +81 52 853 8074 

Dr Ruud Halfens, Praaglaan 123, 6229 HR Maastricht, The Netherlands. 

Ms Tracey Hamlyn, 61 Lydford Park Road, Peverell, Plymouth, PL3 4LQ, England 

Tel: 01752 670601 

Mr Mark Hammonds, Coronary Care Unit, James Cook University Hospital, 

Marton Road, Middlesborough, TS4 3BW, England 

Tel: 01642 854801, Tel: 01642 854196 

Miss Jane Hampton, 25 Trentham St, Southfields, London, SW18 5AS England. 

Tel: 020 8846 6544, Fax: 020 8846 6543 

Dr Carita Hansson, Dept of Dermatology, Wound Healing Centre, Sahlgrenska 

University Hospital, 41345 Göteborg, Sweden 

Tel: +46 31 342 1000, Fax: +46 31 821 1871 

Mrs Lucy Harper, 50 Somersall Street, Mansfield, Notts., NG19 6EP, England. 

Tel: 01623 456063 lucy@ntlworld,com 

Ms Jussi Heikkila, Kuoppatie 4, PO Box 25, Helsinki, 00731 Finland 

Tel: +358 9 346 2574, Fax: +358 9 346 2576 jussi.heikila@icfgroup.fi 

Dr Eva-Lisa Heinrichs, ConvaTec Ltd, Harrington House, Milton Rd, Ickenham, 

Uxbridge, Middlesex, UB10 8PU, England. 

Tel: 01895 628330, Fax: 01895 628332 eva-lisa.heinrichs@bms.com 

Ms Taina Hemmila, Kuoppatie 4, PO Box 25, Helsinki, 00731 Finland 

Tel: +358 9 346 2574, Fax: +358 9 346 2576 taina.hemmila@icfgroup.fi 

Ms Val Henderson, Tissue Viability Nurse, Joint Equipment Loan Store, 43 

Colbourne Crescent, Nelson Industrial Estate, Cramlingham, Northumberland, 

England 

Mr Jan Hermkens, Weymar Straat 8, Maasbree, 5993 CT, The Netherlands. 

Tel: +31 77 465 2676, Fax: +31 77 465 1599 jan.hermkens@wxs.nl 

Ms Hilde Heyman, Karel VD, Woestynelaan 40, 2630 Aartselaar, Belgium 

Tel: +31 3 289 4087 

Ms Helvi Hietanen, Tonttumuorinkija 1, 02200 Espoo, Finland. 

Tel: +35 85 001 02947, Fax: +35 89 412 5074 hetu.hietanen@magabaud.fi 

Ms Raija Hietikko, Karhusyuontie 14, Fin–02810 Espoo, Finland. 

Tel: +358 50 344 7127, raija.hietikko@hus.fi 



Mrs Monica Hofmann-Rosener, HNE Healthcare, Im Hulsenfeld 19, 40721 

Hilden, Germany. Tel: +49 2013 97110 Fax: +49 2013 971146 

hne.hofrose@t-online.de 

Ms Alison Hopkins, 8 Plas Taliesin, Penarth Marina, Penarth, CF64 1TN, Wales, 

UK hopkins72@yahoo.com 

Dr Ronald Houwing, Department of Dermatology, Deventer Ziekenhuis, Postbus 

5001, 7400-GC Deventer, The Netherlands Tel: +31 570 646666 

Fax: +31 570 677919 houwing@dz.nl 

Ms Ansa Iivanainen, Potnolankatu 5, Mikkeli, 50120 Finland. 

Tel: +358 15 150 632, Fax: +358 15 355 6686 ansa.iivanainen@mikkeliamk.fi 

Mrs Sue Jackson, 180 Ecclesshall Road, Stafford, Staffs ST16 1JA, England 

Tel: +44 (0)1785 253000 

Ms Julie Jordan-O’Brien, Tissue Viability CNS, Nurse Practice Development Unit, 

Beaumont Hospital, Beaumont, Dublin 9, Ireland. 

Tel: +353 1 809 2533 julie.jordanobrien@beaumont.ie 

Dr Wilhelm Jung, Global Category Manager–Debridement, Smith & Nephew 

Medical Ltd, PO Box 81, Hessle Rd, Hull, HU3 2BN, England. 

Tel: 01482 673030, Fax: 01482 673307, willi.jung@smith-nephew.com 

Dr Vesa Juutilainen, Pitkankalliontie 14 B 11, Espoo, 02170 Finland 

vesa.juutilainen@kolumbus.fi 

T. Kaldijk, Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ, Maastricht, 

The Netherlands. Tel: +31 43 387 5912, Fax: +31 43 387 5142 

tka@frev.azm.nl 

Mr Raija Kanniainen, Perkionkuja 5B, 01670 Vantaa 67, Finland. 

Tel: +358 9 270 92793, Fax: +358 9 270 92798 raijakanniainen@hotmail.com 

Dr Paul Keller, University Medical Centre, Utrecht, 3508 GA, The Netherlands 

Tel: +31 30 250 8075 

Ms Helena Kelly, Keaney Medical Ltd, Clinitron House, 6 Greenhills Business Park, 

Talloght, Dublin 24, Ireland. Tel: +353 1 459 6585, Fax: +353 1 459 6634 

Mrs Bernadette Kerry, Lahinch, Durrow, Tullamore, Co. Offaly, Ireland 

Tel: +353 506 28075, Fax: +353 506 31175 bernie.kerry@mhb.ie 

Dr Morris Kerstein, 1214 Valley Road, Villanova, PA 19085–2124, USA 

Tel: 001 610 527 4316, Fax: 001 610 520 9293 LK1122@prodigy.net 

Mrs Joyce Khoulowa, c/o Ward 23, York District Hospital, Wiggington Road, York, 

YO31 8HE, England. Tel: 01904 725966 

Mrs Brenda King, 12 Beckton Ave, Waterthorpe, Sheffield, S20 7NA, England. 

Tel: 0114 271 6416, Fax: 0114 271 6417, brenda.king@virgin.net 

Prof Luther Kloth, Dept of Physical Therapy, Marquette University, PO Box 1881, 

Milwaukee, WI 53201-1881 USA. Tel: 001 414 288 3381, Fax: 001 414 288 5987 

Mr E. Koopman, Deventer Ziekenh Stg, Fesevurstraat 7, 7415 CM Deventer, The 

Netherlands. Tel: +31 (0)570 646 078 koopman@dz.nl 

Me Eva Krahenbuhl, Ardo Medical AG, Gewerbestrasse 19, 6314 Unterageri, 

Switzerland. Tel: +41 417 57 70 70, Fax: +41 417 57 70 71 

eva.krahenbuhl@ardo.ch 

Mr Samuel Krahenbuhl, ARDO Medical AG, Gewerbestrasse 19, 6314 Unterageri, 

Switzerland. Tel: +41 417 54 70 70, Fax: +41 417 54 70 71 

samuel.krahenbuhl@ardo.ch 

Mr Nils Lahmann, Ziegelstr 5, D–10117 Berlin, Germany 

Tel: +49 30 450 529066, Fax: +49 30 450 529900 nils.lahmann@charite.de 

Ms Catriona Lally, Clinical Specialist, Kaymed, Bluebell Industrial Estate, Naas 

Road, Dublin 12, Ireland Tel: +353 1 419 2938, Fax: +353 1 460 2574 

lallyc@kayfoam.com 

Mr Larry Lankard, 8550 Balboa Boulevard, No. 214, Northridge, CA 91325, USA 

Tel: 001 818 894 0744, Fax: 001 818 894 7972 larry.lankard@bgind.com 

Mr Bernier Laurent, Asymptote, Le Green – Rue des Granges, Dommartin, 69380 

France. Tel: +33 478 435 127, Fax: +33 478 435 172 

Miss Sylvia Leonard, 7 Brackendale Grove, Luton, Beds, LU3 2LT, England 

Tel: +44 (0)1582 495036 lem65@tiscali.co.uk 

Ms Sarah Lewis, 14 Lancaster Road, Walthamstow, London, E17 6AJ, England. 

Tel: 020 8503 3921 sarah.lewis@uclh.org 

Ms Doris Liddy, Tissue Viability Nurse, UCHG, Newcastle Road, Galway City, 

Ireland. Tel: +353 (0)91 542115, doris.liddy@hsi.ie 

108 

Mrs Pirjo Lietzen, Jonsaksenpolku 1 A 22, Fin–01600 Vantaa, Finland 

Tel: +358 50 372 0280, Fax: +358 9 310 50330 pirjo.lietzen@luukku.com 

Dr Christina Lindholm, Director Clinical Research, Karolinska Hospital, S–171 76 

Stockholm, Sweden. Tel: +46 8 517 798 82, Fax: +46 8 517 799 68 

christina.lindholm@ks.se 

Mr Armin Littek, Box 14435, Kilkirnie, Wellington, New Zealand 

Tel: +64 4 383 5790, Fax: +64 4 383 5797 armin@med-dev.co.nz 

Mrs Menna Lloyd-Jones, Beechwood House, Bridge Street, Dolgellau, LL40 1AU, 

Gwynedd, Wales, UK Tel: +44 (0)1341 421412, Fax: +44 (0)1341 422059, 

menna.jones@nww-tr.wales.nhs.uk 

Ms Pille Loit, Tammsaane 61–9, 13715 Tallinn, Estonia 

Tel: +372 51 84008, Fax: +372 67 11509 

Mr Reinier J. Lorist, Oude Waal t.o.10, 1011 CG, Amsterdam, The 

Netherlands Tel: +31 20 62 02962, Fax: +31 20 599 2299 r.j.lorist@olvg.nl 

Dr Maarten Lubbers, Surgeon AMC, Meibergdreef 9 1105 AZ, Amsterdam, The 

Netherlands. Tel: 00 31 20 566 9111, Fax: 00 31 20 697 2988 

Ms Elja Luotola, Hakalantanhua 15, Fin–29100 Luvia, Finland 

Tel: +358 2 558 3300, eija.luotola@jippii.ji 

Ms Yvonne Lutgens, Nieuwe Uilenburgerstraat 10B, 10011 LP Amsterdam, The 

Netherlands. Tel: +31 20 566 9111 Fax: +31 20 566 9568 

y.h.lutgens@amc.uva.nl 

Ms Gwendolyn Macintyre, 153 Kilpatrick Gardens, Clarkston, Glasgow, G76 7RN, 

Scotland, UK Tel: +44 (0)141 638 0360 billmacintyre@yahoo.co.uk 

Ms Lybda Mapplebeck, Tissue Viability Specialist, Kingsley Grove Clinic, Grimsby, 

Lincs, DN33 1NL, England 

Mr George Maroutsis, 24 Filellinon Street, Halandri, GR–152, 32 Athens, Greece 

Tel: +30 168 12 522, Fax: +30 168 16 706 gmaroutsis@msjacovides.com 

Mr Andrew Cox Martin, Dept of Medical Engineering, Salisbury District Hospital, 

Salisbury, Wilts, SP2 8BJ, England. Tel: 01722 425138 Fax: 01722 416227 

bill@medengsdh.demon.co.uk 

Mrs Laura Martin, 6 Parkgate Road, Temple Patrick, Ballyclare, BT39 0DF, 

Northern Ireland. Tel: 028 9443 2667 laura@martinparkgate.freeserve.co.uk 

Mrs Ruth Martin, Wound Care Team, Wandsworth PCT, St John’s Therapy Centre, 

162 St John’s Hill, Battersea, London, SW11 1SP. Tel: +44 (0) 208 700 0232 

Fax: +44 (0) 208 700 0203 ruth.martin@swlondon.nhs.uk 

Dr Marco Masina, Via Andrea Costa 5, S Giorgio Di Piano (BO), 40016 Italy 

Tel: +39 339 305 1053, Fax: +39 051 66 44491 marc_mas@yahoo.com 

Mr John Masso, 412 Hancock Place, Fairview, New Jersey, 07022–1810, USA 

Tel: 001 201 941 8493, Fax: 001 201 943 1726 chichimambo@ix.netcom.com 

Mr Anton Mayrhauser, Ketzergasse 39 (FA Sunmed), 1232 Vienna, Austria 

Tel: +43 1699 2299 Fax: +43 1699 2299-1 mayrhauser@ sunmed.at 

Dr Alistair McLeod, Huntleigh Technology PLC, 310-312 Dallow Road, Luton, 

LU1 1TD, England. Tel: 01582 745768, Fax: 01582 745862 

Ms Mary McMahon, St Joseph’s Ward, Cappagh National Orthopaedic Hospital, 

Finglas, Dublin 11, Ireland. 

Ms Geraldine McNulty, 8 Avondale Court, Manor West, Tralee, Co. Kerry, Ireland. 

Tel: +353 66 712 1314, Fax: +353 66 712 4515 grmcn@eircom.net 

Mr Kevin Mearns, Talley Group Limited, Premier Way, Abbey Park Industrial 

Estate, Romsey, Hants, SO51 9AQ, England. Tel: 01794 503557, 

Fax: 01794 503555 kmearns@talleymedical.co.uk 

Dr Sylvie Meaume, Hopital Charles Foix, 7 Avenue de la Republique, Ivry sur 

Seine, 94205, France Tel: 00 33 149 594 504, Fax: 00 33 149 594 524 

sylvie.meaume@cfx.ap-hop-paris.fr 

Dr Elke Mertens, Wielandstr 24, 12159 Berlin, Germany 

Tel: +49 30 859 1136, Fax: +49 30 450 529 900 elke.mertens@charite.de 

Mrs Janine Michaelides, The Cyprus Ass. of Cancer Patients and Friends, 6 Pindou 

Street, Limassol 3035, Cyprus. Tel: +357 574 7750, Fax: +357 574 7668 

janinemichaelides@yahoo.com 

Mrs Christina Miguens, R Rangel de Lima, No. 12, 3320–229 Pampilhosa Da Serra, 

Portugal miguens.gouveia@clix.pt 

Mrs Zena Moore, Kuldana, 11 Beech Park Avenue, Castleknock, Dublin 1, Ireland. 

Tel: +353 1 821 6775, Fax: +353 1 414 3576 zena.moore@amnch.ie 


Ms Margaret Moriaty, Tissue Viability Specialist, Dartford, Gravesend and Swanley 

PCT, Gravesend Hospital, Ward M4, Bath Street, Gravesend, Kent, DA1 0DG, 

England. Tel: 01474 564333 

Mr Will Morris, Pinfold House, Pinfold Lane, Alltami Mold, Flintshire, CH7 6NZ, 


willmorris@nightingalebeds.co.uk 

Mrs Deborah Murphy, 28 Tintagel Close, Feniscowles, Blackburn, Lancs, BB2 5JN. 

England Tel: +44 (0)1254 201253 debmurphy123@hotmail.com 

Mr Olavi Murros, Kuoppatie 4, PO Box 25, 00731 Helsinki, Finland. 

Tel: +358 9 346 2574, Fax: +358 9 346 2576 olavi.murros@icfgroup.fi 

Mrs Anne Myer, 22951 Femes, Mission Viejo, California, 92692–1424, USA 

Tel: +1 949 770 9316 Fax: +1 949 767 5998 woundcare@cox.net 

Mrs Marilyn-Agnes Ngoh, 11 Maxwell Court, Dulwich Common, London, SE22 

8NT, England Tel (+Fax): +44 (0)20 8299 6690 mangoh2001@aol.com 

Mrs Jane Nixon, Centre for Evidence Based Health Care, University of Huddersfield, 

Harold Wilson Building, Queensgate, Huddersfield, HD1 3DH, England. 

Tel: 01484 473645 j.nixon@hud.ac.uk 

Ms Birgit Nordlund, Salamapujankatu 18, F 41, Fin–65370 Vaasa, Finland 

Tel: +358 6 316 9617 birgit.nordlund@vshp.fi 

Mrs Pirjo Nurminen, Simpukkakie 14, Fin–48310 Kotka, Finland 

Tel: +358 5 2604 181 (or +358 40 7409 709) pirjo.nurminen@kymshp.fi 

Mrs Pia Obank, Lane End Surgery, Finings Road, Lane End, Bucks, HP14 3ES, 

England Tel: 01494 883364 

Miss Louise O’Connor, 37 Clough House Drive, Leigh, Lancashire, WN7 2GD, 

England. Tel: 0161 291 3227 louise.oconnor@smunt.nwest.nhs.uk 

Mrs Linda O’Flynn, Holly Lodge, 57 London Road, Datchet, Berks, SL3 9JY, 

England Tel: 01753 545640, Fax: 01753 860441 

linda-oflynn@btinternet.com 

Dr Takehiko Ohura, Kojinkai Pressure Ulcer Wound Healing Res. Center, 

7F, H&B Plaza Bld 1-1, West 2, South 3, Chuo-ku, Sapporo, 060–0063 Japan 

Tel: +81 11 232 2208, Fax: +81 11 232 5181 t.ohura@mb.snowman.ne.jp 

Dr Cees Oomens, Eindhoven Univ of Technology, Mech Eng Dept, PO Box 513, 

5600 MB, Eindhoven, The Netherlands. Tel: +31 40 247 2818, 

Fax: +31 40 244 7355 oomens@wfw.wtb.tue.nl 

Dr Forma Ormella, Via Carlo Porte 3, Voltorre di Gavirate, Varese 21026, Italy 

Tel: +39 033 2828 443 or 730372 pamisua@tin.it 

Ms Sandra O’Shaughnessy, 32 Kilbane Golf Links Road, Castletroy, Limerick City, 

Ireland Tel: +353 61 331153, Fax: +353 61 331179 

sandra.o’shaughnessy@smith-nephew.com 

Ms Angela Parlane, Flat 59, 135 Warwick Road, London, W14 8NJ, England. 

Tel: 07810 026534, angelapsyd@hotmail.com 

Ms Claudia Parnell, Tissue Viability Specialist, Hawthorn Road Clinic, Hawthorn 

Rd, Strood, Kent, ME2 2HU, England 

Mrs Elaine Penn, Kent House, Princess Marina Hospital, Upton, Northampton, 

NN5 6UH, England Tel: +44 (0)1604 595215 

elaine.penn@nht.nhs.uk 

Dr Jeanne Perla, 10 Center Road, Orchard Park, New York 14217, USA 

Tel: +1 716 662 8662, Fax: +1 716 662 8624 jperla@gaymar.com 

Mrs Anne-Marie Perrin, 13 Pettitts Lane, Dry Drayton, Cambs, CB3 8BT, England. 

Tel: 01954 780467, Fax: 01954 789729 annemarieperrin@aol.com 

Mrs Lyn Phillips, Huntleigh Healthcare, 312 Dallow Road, Luton, LU1 1TD, 


lyn.phillips@huntleigh-healthcare.com 

Dr Chryssanthi Plati, Univ of Athens, Fragokklissias 12 Str, 15125 Marousi, Athens, 

Greece. Tel/Fax: +301 61 98 619 

Dr Ivan Poromanski, 21 Macedonia Blvd, Mhatem, Pizogou Clinic of Septic 

Surgery, Sofia 1606, Bulgaria Tel: +359 887 439 170, Fax: +359285 173 15 

ivan_poromanski@yahoo.com 

Mrs Maria Priami, Univ of Athens, Fragokklissias 12 Str, Marousi, 15125 Athens, 

Greece. Tel/Fax: +301 61 98 619 

Dr Patricia Price, Wound Healing Research Unit, Cardiff Medicentre, Heath Park, 

Cardiff, CF14 4UJ, Wales, UK Tel: 02920 682 179, Fax: 02920 754 217 

pricepe@whru.co.uk 

Mr Nigel Quinn, Pinfold House, Pinfold Lane, Alltami Mold, Flintshire, CH7 6NZ, 


nigelquinn@nightingalebeds.co.uk 

Dr Steven Reger, Cleveland Clinic Foundation – C21, Dept of Physical Medicine 

Rehabilitation, Cleveland, 44195 Ohio, USA 

Tel: +1 216 444 1801, Fax: +1 216 445 7000 regers@ccf.org 

Mr Claude Regnier, 204 Avenue du Marechal Juin, Boulogne 92104, France. 

Tel: +33 141 10 53 00, Fax: +33 144 84 08 44 claude.regnier@bbraun.com 

Prof Elia Ricci, Via P. Crotta 8, 10010 Cascinette d’Ivrea, (TO) Italy 

Tel: +39 011 544 747, Fax: +39 011 533 649 eliaricci@tin.it 

Dr Shyam Rithalia, School of Healthcare Professionals, University of Salford, Brian 

Blatchford Building, Salford, M6 6PU, England Tel: 0161 295 2286, 

Fax: 0161 295 2302 s.rithalia@salford.ac.uk 

Dr Marina Ritter, Polyheal Ltd, 44 Bar Jehuda Str, Nesher, 20300 Israel 

Tel: +972 4 820 7917, Fax: +972 4 820 7919 marina@polyheal.co.il 

Dr Vladimire Ritter, Polyheal Ltd, 44 Bar Jehuda Str, Nesher, 20300 Israel 

Tel: +972 4 820 7917, Fax: +972 4 820 7919 

Mr Stefan Roales-Welsch, An der Hauptstr 36, 35287 Amoneburg, Germany 

Tel: +49 (0)6421 286 2739 srowe@gmx.de 

Dr Marco Romanelli, Department of Dermatology, University of Pisa, Via Roma 67, 

56126 Pisa, Italy. Tel: +39 050 992 436, Fax: +39 050 551 124 

Ms Marianne Rosager, Brunzevej 1–8, 3060 Espergaerde, Denmark 

Tel: +45 49 11 11 11 dkmro@coloplast.com 

Mr Joao Carlos Rua Rangel de Lima,12 Pampilhosa Da Serra, 3320–229 Portugal 

Tel: +351 235 594 728 miguens.gouveia@clix.pt 

Dr David Ryan, GITU Freeman Hospital, Newcastle upon Tyne, NE7 7DN, 

England. Tel: +44 (0)191 284311 (x 26423), Fax: +44 (0)191 223401 

David.Ryan@nuth.northy.nhs.uk 

Dr Paini Salminen-Peltola, Kuusaankuja 2, Jarvenpaa, 04430 Finland 

paivi.salminen-peltola@hus.fi 

Prof Hiromi Sanada, 5-11-80 Kadatsuno, Kanazawa, Dept of Nursing, School of 

Health Sciences, Kanazawa University, 920-0942 Japan. Tel: +81 76 265 2554 

Fax: +81 76 234 4363 sanadaf@kenroku.kanazawa-u.ac.jp 

Ms Salla Sappanen, Kaarikatu 32, Fin–86300 Culainen, Finland 

Tel: +358 50 320 6832 Fax: +358 8 479 3432 salla.sappanen@pp.inet.fi 

Miss Susam Sayer, 4 Earlston Place, Edinburgh, EH7 5SU, Scotland 

Tel: +44 (0)131 661 4931 suesayer33@hotmail.com 

Dr J.M.G.A. Schols, Vlaaikensstraat 2, 4944 XL Raamsdonk, The Netherlands 

Tel: +31 162 52 0464 jmga.schols@worldonline.nl 

Ms Lisette Schoonhoven, University Medical Center Radboud, Verplegingsweterschap 

229, PO Box 9101, 6500 HB Nijmegen, The Netherlands. 

Tel: +31 24 361 0458, L.schoonhoven@med.uu.nl 

Dr Wayne Schroeder, 8023 Vantage Dr, PO Box 659508, San Antonio, 78265-9508 

Texas, USA. Tel: 001 210 554 5396, Fax: 001 210 255 6988 schroedw@kci1.com 

Mrs Eileen Scott, Prof. Unit of Surgery, North Tees & Hartlepool NHS Trust, 

Stockton on Tees, TS19 8PE, England. Tel: 01642 624087, Fax: 01642 624165 

Mrs Pamela Scott, Park View, Bothel, Wigan, Cumbria, CA7 2JD England 

Tel: +44 (0)7939 821567 

Dr Joseph Selkon, 4 Ethelred Court, Oxford, OX3 9DA, England. 

Tel: 01865 764098, Fax: 01865 764098 

EPUAP MEMBERS 

Mrs Catherine Sharp, 3 Salisbury Street, South Hurstville, Sydney 2221, Australia 

Tel: +61 2 959 4148 Fax: +61 2 958 50393 catherine 410@hotmail.com 

Miss Helen Shearer, 164 Scalby Road, Scarborough, North Yorkshire, TO12 6TB, 

England Tel: 01723 3754525 hcs164@hotmail.com 

Ms Helen Smyth, Anglia Polytechnic University, School of Healthcare Practice, 

24 Park Road, Chelmsford, Essex CM1 1LL, England 

Tel: 01245 493131 (x 4142), Fax: 01245 250368 h.smyth@apu.ac.uk 

Mr Javier Soldevilla, Agreda Avda de Navarra, 8-10, 4-D, Logrono, 26001, Spain. 

Tel: +34 41 251 392, Fax: +34 41 22 03 44 

Ms Jackie Stephen-Haynes, Stourport Health Centre, Worcester Street, Stourport 

on Severn, Worcs, DY13 8EH, England. Tel: +44 (0)1299 827131 

jackies_h@btopenworld.com 



Mrs Fiona Stephens, 16 Strangford Rd, Tankerton, Whitstable, Kent, CT5 2EP, 

England. Tel: 07711 479668 fiona.stephens@rcn.org.uk 

Dr Thomas Stewart, Gaymar Industries Inc, 10 Center Drive, Orchard Park, 

NY-14127, USA 

Mrs Lesley Stockton, Department of Allied Health Professionals, OT Division, 

University of Liverpool, Thompson Yate Building, Brownlow Hill, Liverpool, 

L69 3GB, England Tel: +44 (0)151 794 5722, Fax: +44 (0)151 794 5719, 

lesley2@liv.ac.uk 

Mr Alan Sullivan, Meditec Medical Ltd, Unit 7, Ida Business Centre, Whiteltown 

Industrial Estate, Tallaght, Dublin 24, Ireland 

Mrs Varda Swager, Hoshav Serufa Doan Nah, Hof Ha Carmel, 30850, Israel. 

Tel: +972 4984 2928 Fax: +972 4854 2750 

Dr Ian Swain, Dept of Medical Physics and Bio. Engineering, Salisbury District 

Hospital, Salisbury, SP2 8BJ, England. Tel: 01722 336262 (x 4065), 01722 425263 

Ms Anna-Britta Tallberg, Vaksala Svia, 75594 Uppsala, Sweden, Tel: +46 18 31 

7412, Fax: +46 18 611 2460 anna-britta-tallberg@kirurgi.uas.lul.se 

Ms Anu Tammemae, Sytiste Str 19, North Estonian Regional Hospital, 13419 

Tallinn, Estonia Tel: +372 697 1371, Fax: +372 697 1200 

Ms Antje Tannen, Stresowplatz 1, 13597 Berlin, Germany. Tel: +49 30 529 066, 

Fax: +49 30 529 900 antje.tannen@charite.de 

Dr M Barden ter Haar, BES Rehab Ltd, 9 Cow Lane, Fulbourn, Cambridge, 

CB1 5HB, England. Tel: 01223 882105, Fax: 01223 882105 

b.e.s.rehab@btconnect.com 

Mr Andrew Thelwell, 2 Royal Farm Mews, Edgewell Lane, Eaton, Tarporley, 

Cheshire, CW6 9XE, England Tel: +44 (0)1244 584330 

Fax: +44 (0)1244 548311 andrew.thelwell@bms.com 

Mr Geoff Thompson, Specialist Nurse Manager, Equipment Resource Centre, 

Heartlands Hospital, Bordsley Green, Birmingham B9 5SS, England 

Tissue Viability Team, Room 15, Chalmers Keddie Building, The Royal Oldham 

Hospital, Rochdale Road, Oldham, OL1 2JH, England Tel: +44 (0)161 627 8701 

Mr Tore Tomter, Tordivelen 20, Hamar, N-2316 Norway. Tel: +47 625 26272, 

Fax: +47 625 21211 tore@togemo.no 

Dr Joan Enric Torra i Bou, Galle 5. Bis, Barcelona, 08021, Spain. 

Tel: +34 3731 0474 

Dr Ciril Triller, Dept of Surgical Infections, Medical Centre Ljubljana, Zaloska 2, 

1000 Ljubljana, Slovenia Tel: +386 1 31§ 362 533, Fax: +386 1 522 2398 

triller@sirl.net 

Mrs Ulla-Maija, Tuuliranta, Purokatu 15B, Fin–40600, Finland. 

Tel: +358 14 244 885 mikko.tuuliranta@kolumbus.fi 

Ms Geri Usberg, 2 L Punsep St, Tartu University Clinics, Tartu, 51003 Estonia 

Tel: +372 566 32818 gerli67@hot.u 

Dr Dirk van de Looverbosch, Turnhoutseraan 111, 2100 Deurne, Belgium 

Tel: +31 3 325 0965 medresearch@wanadoo.be 

Mr Bart Van der Heyden, Houtstraat 74, 9070 Destelbergen, Belgium. 

Tel: +32 (0)9356 7222, Fax: +32 (0)9356 6915 bvanderheyden@attyglobal.net 

Mr Han van der Mijn, Niewe Achtergracht 100, Amsterdam, 1018 WT, The 

Netherlands. Tel: +31 20 624 3079, Fax: +31 20 638 7960 

hbjvdmijn@fbadam.nl 

Dr Katrien Vanderwee, Ghent University, uz Gent – Blok A 2de V, De Pintelaan 

185, Gent, 9000 Belgium. Tel: (and Fax:) +32 9 1240 3694 

katrien.vanderwee@rug.ac.be 

Mr Edwin Van der Zee, Krommekamp 232, Harderwijk, 3848 DT, The Netherlands 

Tel: +31 341 4189214, Fax: +31 341 422957 vanderzee@globalxs.nl 

Mrs Tracy Vernon, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, Yorks, 

DN2 5LT, England. Tel: 01302 366666 (ext. 3359), Fax: 01302 320098 

Ms Heidi Vrijdagh, Huntleigh Healthcare, Stapelplein 70, 9000 Gent, Belgium 

Tel: +32 9 265 8770, Fax: +32 9 265 8771 heidi.vrijdagh@huntleigh-healthcare.be 

Jan Weststrate, University Hospital Rotterdam, Room H–897 Erasmus Medical 

Centre, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands. 

Tel: +31 10 463 4237, Fax: +31 10 463 4234 weststrate@aziv.azr.nl 

Miss Emma Wheat, 89 Llanishen Street, Heath, Cardiff, CF14 3QD, Wales, UK 

Tel: 02920 404729 ewheat@uwic.ac.uk 

110 

Mr Arthur Wheeler, 1 Samsworth Close, Castor, Peterborough, Cambs. PE5 7BQ, 

England. Tel: 01733 380774 

Ms Ann Wilson, Tissue Viability Nurse, Queen Margaret Hospital, Whirefield 

Road, Dunfermline, Fife, KY12 0SU, Scotland. Tel: 01383 623623 

Mrs Ann Withington, 10 Barnfield Crescent, Wellington, Telford, Shropshire 

TF1 2ES, England. Tel: 01952 641222 p.a.withington@tesco.net 

Mr David Woolfson, Kaymed, Bluebell Industrial Estate, Naas Rd, Dublin 12, 

Ireland. Tel: +353 1 419 2999, Fax: 353 1 460 2574 kaymed@kayfoam.com 

Mrs Frances Worboys, Block 2, Mile End Hospital, Bancroft Rd, London, E1 4DG, 

England. Tel: 020 7377 7873 Fax: 020 7377 7802 fran.worboys@thpct.nhs.uk 

Ms Trudie Young, School of Nursing, Glan Clwyd Hospital, Bodelwyddan, 

Denbighshire, LL18 5UJ, Wales, UK Tel: +44 (0)1745 534380, 

Fax: +44 (0)1745 534960 t.young@bangor.ac.uk 

Mr Ireneusz Zbronski, ul Kasztanowa 27, Olsztyn, 10–156 Poland. 

Tel: +48 89 533 1013, Fax: +48 89 533 3978 real@real.olsztyn.pl 


epuap Membership 


Application Form, 2003–4 

MISSION STATEMENT 

The European Pressure Ulcer Advisory Panel’s objective is to provide the 

relief of persons suffering from, or at risk of pressure ulcers, in particular 

through research and the education of the public. The European Pressure 

Ulcer Advisory Panel is a registered charity, number 1066856. 

MEMBERSHIP APPLICATION PLEASE PRINT CLEARLY 

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Membership fee: £30 per year (September – September) 

Which includes Certificate of Membership plus the EPUAP Review 

Cheques should be made payable, in British Pounds drawn on a UK Bank, to: 

EPUAP Registered Charity 1066856 

And application forms should be returned to: 

EPUAP Business Office, 

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112 

C O R P O R A T E M E M B E R S 

A N D S P O N S O R S O F T H E 

A N N U A L O P E N M E E T I N G 

O F T H E E P U A P 

3M 

Augustine Medical 

B. Braun Medical S.A. 

ConvaTec 

Cook 

Frontier Therapeutics 

Gaymar Industries Inc 

Hill-Rom Europe 

Huntleigh Healthcare 

Paul Hartmann AB 

Johnson & Johnson 

KAYMED 

Mölnlycke Healthcare AB 

Nutricia Healthcare 

Pegasus Ltd 

ROHO 

Smith & Nephew 

Tempur U.K. Ltd 

URGO 

Designed and produced by John Brennan at the Positif Press, Oxford 

Tel: +44 (0)1865 243220 Fax: +44 (0)1865 243272 

Printed by Oxuniprint at Oxford University Press 

© European Pressure Ulcer Advisory Panel, 2003 

ISSN 1464–7796

EPUAP Review 5/3 RIP - European Pressure Ulcer Advisory Panel

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