EPUAP Review 5/3 RIP - European Pressure Ulcer Advisory Panel
EPUAP Review 5/3 RIP - European Pressure Ulcer Advisory Panel
EPUAP Review 5/3 RIP - European Pressure Ulcer Advisory Panel
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epuap<br />
Mission Statement<br />
Executive Committee Members:<br />
Trustees:<br />
<strong>EPUAP</strong> Business Office:<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Trustees of the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong><br />
The <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>’s objective is to provide the<br />
relief of persons suffering from, or at risk of pressure ulcers, in particular<br />
through research and the education of the public.<br />
Denis Colin: President (France)<br />
Michael Clark: Recorder (Wales)<br />
Marco Romanelli: Past President (Italy)<br />
George Cherry: Secretary/Treasurer (England)<br />
Christina Lindholm (Sweden)<br />
Sue Bale (Wales)<br />
Brigitte Barrois (France)<br />
Andrea Bellingeri (Italy)<br />
Mark Collier (England)<br />
Theo Dassen (Germany)<br />
Carol Dealey (England)<br />
Tom Defloor (Belgium)<br />
Jacqui Fletcher (England)<br />
Katia Furtado (Portugal)<br />
Finn Gottrup (Denmark)<br />
Laszlo Gulacsi (Hungary)<br />
Jeen Haalboom (Netherlands)<br />
Ruud Halfens (Netherlands)<br />
Helvi Hietanen (Finland)<br />
Maarten Lubbers (Netherlands)<br />
Zena Moore (Eire)<br />
Elia Ricci (Italy)<br />
Anne Witherow (Northern Ireland)<br />
Administrator: Christine Cherry (England)<br />
68 Church Way<br />
Iffley, Oxford, OX4 4EF, UK<br />
Tel: +44 (0)1865 714358<br />
+44 (0)1865 228269<br />
Fax: +44 (0)1865 714373<br />
+44 (0)1865 228233<br />
E-mail: <strong>European</strong><strong>Pressure</strong><strong>Ulcer</strong>Advis<strong>Panel</strong>@compuserve.com<br />
Volume 5, Number 3, 2003 77
78<br />
epuap<br />
Dr Michael Clark<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Letter from the Editor<br />
EDITORIAL<br />
THIS has been a busy year for the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong><br />
<strong>Panel</strong> – a successful conference held in Tampere, Finland along with<br />
a new guideline on nutrition and pressure ulcers mark just two of<br />
the year’s highlights. What does the New Year hold in store? First of all <strong>EPUAP</strong><br />
are one of the co-hosts of the 2 nd World Union of Wound Healing Societies<br />
conference to be held in Paris over six days in July 2004 (8 th to the 13 th ).<br />
This will be the major wound event during the year and sees a coming together<br />
of several <strong>European</strong> wound organisations. It is expected that several<br />
thousand delegates will attend the Paris meeting – such numbers may be<br />
usual within many major medical conferences but this concentration of professions<br />
and skills within a single wound meeting is unique. What can <strong>EPUAP</strong><br />
members expect from our participation within the World Union event? Although<br />
we are a co-host the main programme has been developed by the<br />
World Union committee and not by the <strong>EPUAP</strong>. This means that although<br />
pressure ulcers will be represented in depth during the conference there<br />
may be fewer opportunities for <strong>EPUAP</strong> projects to be reported within the<br />
main sessions. The potential lack of a focus upon the actions of the <strong>EPUAP</strong><br />
will of course be offset by the opportunity to network with colleagues from<br />
almost all parts of the world!<br />
Another project in gestation during 2004 will be a pressure ulcer textbook<br />
prepared by the <strong>EPUAP</strong> and to be published by Springer-Verlag. This<br />
text will draw together the experience of <strong>EPUAP</strong> members to create a key<br />
publication on all aspects of pressure ulceration. Over the first few months<br />
of 2004 the Editors of this new book will be working with the chapter authors<br />
to bring the text to completion. A publication date has not yet been set<br />
but it is hoped that you will be able to obtain copies of this <strong>EPUAP</strong> text<br />
around the end of 2004.<br />
This issue of the <strong>EPUAP</strong> <strong>Review</strong> illustrates how <strong>EPUAP</strong> members have<br />
been helping to develop new evidence based consensus regarding support<br />
surface use in Italy. The article concludes with a call for members to get<br />
involved with this project by sharing their national and regional guidelines<br />
on support surfaces. There are now many guidelines available to help shape<br />
both pressure ulcer prevention and treatment; but which ones are worth<br />
adopting? Formal evaluation of pressure ulcer guidelines will also be a focus<br />
within this newsletter over the coming year; so watch out for how well your<br />
national guidelines compare with others!<br />
Michael Clark<br />
Editor<br />
Volume 5, Number 3, 2003
epuap Letter<br />
Denis Colin<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
from the President<br />
Dear Friends,<br />
Ifeel very happy and proud to be the fourth President of the <strong>European</strong><br />
<strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>. As the new President I wanted to take the<br />
opportunity to share my commitment for the vision and future of the<br />
<strong>EPUAP</strong>. First of all let us go back to our mission statement: ‘The <strong>EPUAP</strong><br />
objective is to provide the relief of persons suffering from, or at risk of pressure<br />
ulcers, in particular through research and the education of the public’.<br />
To what extent have we met these objectives? Considerable progress has been<br />
made – through the <strong>EPUAP</strong> working groups, the <strong>EPUAP</strong> <strong>Review</strong>, our web site<br />
and of course the annual meetings which are always a large success in terms<br />
sharing knowledge and expertise. This year I believe the <strong>EPUAP</strong> made a<br />
decisive step during our seventh Open Meeting in Tampere where we asked<br />
‘have we made a difference?’ I am confident that we have indeed made that<br />
difference and would like to thank all those people who have been involved<br />
in making the <strong>EPUAP</strong> what it is today. However, we cannot be complacent,<br />
resting on past success. We have to continue to move forward towards our<br />
objective – the relief of persons suffering from pressure ulcers.<br />
In its short lifetime the <strong>EPUAP</strong> has also shown a model whereby we in<br />
Europe can work together for the common benefit of those who face pressure<br />
ulcers. This capacity for sharing and learning from one another is a key<br />
step towards winning the war against pressure ulcers and marks our unity<br />
throughout Europe and across the world.<br />
Happy new year 2004!<br />
Denis Colin<br />
President<br />
Volume 5, Number 3, 2003 79
80<br />
epuap Report<br />
Clinical Need for this Guideline<br />
<strong>Pressure</strong> ulcers are the result of a complex interplay between<br />
myriad extrinsic and intrinsic risk factors – excessive<br />
mechanical loading, immobility, incontinence, advanced<br />
age among many others. While the consequences of immobility<br />
are often viewed as the key predisposing factors in<br />
prompting the development of a pressure ulcer, it is often<br />
assumed that there is also a direct causal relationship between<br />
nutrition and pressure ulcer development. The scientific<br />
basis for this assumption is unclear with as yet no<br />
sound studies linking impaired nutrition and an increased<br />
incidence of pressure ulcers. However, it is possible that<br />
impaired nutrition may influence tissue vulnerability to<br />
extrinsic factors such as pressure. It is important to note<br />
that only a few risk factors can be influenced by our actions<br />
– tissue loading and nutrition being two key issues we can<br />
address. The perceived importance of malnutrition in pressure<br />
ulcer development and management is briefly considered<br />
within existing <strong>EPUAP</strong> guidelines; for example:<br />
• A full risk assessment in patients to include: General<br />
skin condition, skin assessment, mobility, moistness<br />
and incontinence, nutrition and pain.<br />
• Following assessment nutritionally compromised<br />
individuals should have a plan of appropriate support<br />
and/or supplementation that meets individual needs<br />
and is consistent with overall goals of therapy.<br />
• Ensure adequate dietary intake to prevent malnutrition<br />
to the extent that this is compatible with the<br />
individual’s wishes or condition.<br />
The purpose of this guideline is to expand upon the<br />
references to malnutrition within existing <strong>EPUAP</strong> guidelines<br />
and provide clinicians with specific guidance upon<br />
nutritional screening and assessment and following assessment,<br />
appropriate intervention. It is intended that the<br />
guidelines be appropriate for all care settings although it is<br />
recognized that the access to specific tools such as weighing<br />
scales and personnel such as dieticians may be limited<br />
in some sectors. <strong>EPUAP</strong> recognize that other clinical guidelines<br />
on nutrition exist (for example: Obesity in Scotland,<br />
Integrating Prevention with Weight Management, SIGN<br />
Guideline no. 8, 1996) and that the specific guidance<br />
<strong>EPUAP</strong> offers on nutrition and pressure ulcers should be<br />
considered within the context of general guidelines on nutritional<br />
management.<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
from the Guideline Development Group<br />
GUIDELINE ON NUTRITION IN PRESSURE ULCER PREVENTION AND TREATMENT<br />
Final version – Following helpful comments from Tampere meeting and <strong>EPUAP</strong> members<br />
Text prepared by Michael Clark on behalf of the Guideline Group, 16 November 2003<br />
The recommendations offered in this guideline have been<br />
graded using the following systems:<br />
Source of evidence that underpins the<br />
recommendation<br />
I Evidence from systematic review or meta-analysis of<br />
randomised controlled trials or at least one<br />
randomised controlled trial.<br />
II Evidence from at least one controlled trial without<br />
randomisation or at least one other type of quasiexperimental<br />
study.<br />
III Evidence from non-experimental descriptive studies,<br />
such as comparative studies, correlation studies and<br />
case-control studies.<br />
IV Evidence from expert committee reports or opinions<br />
and/or clinical experience of respected authorities.<br />
Recommendation Grading<br />
A Directly based on category I evidence.<br />
B Directly based on category II evidence or extrapolated<br />
recommendation from category I evidence.<br />
C Directly based on category III evidence or extrapolated<br />
recommendation from category I or II evidence.<br />
D Directly based on category IV evidence or extrapolated<br />
recommendation from category I, II or III<br />
evidence.<br />
Both grading systems were adapted from Eccles, M. and<br />
Mason, J. (2001). How to develop cost-conscious guidelines.<br />
Health Technology Assessment 5:8.<br />
Structure of the Guideline<br />
The recommendations of this guideline are considered to<br />
apply to both the prevention and management of pressure<br />
ulcers. Where guidance relates solely to pressure ulcer treatment<br />
this will be highlighted in the text. It should also be<br />
noted that the <strong>EPUAP</strong> considers all recommendations to<br />
be equally valid regardless of the grade of evidence upon<br />
which they are based. In the following recommendations<br />
where a source and level of evidence is not explicit, the<br />
recommendation should be considered as a level IV, D recommendation.<br />
Volume 5, Number 3, 2003
Screening and Assessment of nutritional status<br />
Screening and assessment of an individual’s nutritional status<br />
can be performed using a number of measures ranging<br />
from tools such as the Subjective Global Assessment (Detsky<br />
et al 1987) to relatively simple measures of height and weight<br />
(combined as Body Mass Index). However, some measurements<br />
(height, laboratory tests, skin fold thickness) may not<br />
be readily available in all care settings. Undesired weight<br />
loss (>10% of normal body weight in the past six months,<br />
or >5% in the past month) may provide an indication of<br />
malnutrition although where possible reasons for this unintentional<br />
weight loss should be explored with the individual<br />
patient.<br />
Accurate measurement of body weight and height, and<br />
hence Body Mass Index, may be problematical in many settings<br />
through lack of available equipment or challenges in<br />
measuring body length among some patient groups. BMI<br />
measures have also been found to be less valid within some<br />
patient groups, such as children and the very elderly, due<br />
to their altered/different fat/lean body mass ratio.<br />
Recording patient weight should follow a specified protocol,<br />
where the individual is weighed ideally at the same<br />
time of day using the same scales with an appropriate weight<br />
range (up to 350kg). Before weighing, any outdoor clothes<br />
and shoes should be removed. If possible all weight measurements<br />
should be made by a single recorder. In addition<br />
to weight measurement, waist circumference is a reliable<br />
marker for intra-abdominal fat mass. The waist measurement<br />
should be carried out at a specific location half-way<br />
between the superior iliac crest and the rib cage, in the<br />
mid-axillary line.<br />
Nutritional assessment may also include nutritional intake<br />
over the past 1, 3 or 7 days; this information may be<br />
gathered using 24-hour recall, self or carer reported food<br />
intake records or through the involvement of a dietician,<br />
where available. It is important to consider why the intake<br />
of food and fluids is at the reported level.<br />
Biochemical measurements such as serum albumin,<br />
hemoglobin and potassium may be helpful when considering<br />
the nutritional status of the ill although these indicators<br />
may provide more information upon chronic, rather<br />
than acute depletion of specific nutrients. In general it is<br />
unlikely that biochemical measurements will provide more<br />
information than other indicators such as undesired weight<br />
loss although a number of studies cite an association between<br />
albumin and pressure ulcers.<br />
The use of nutritional screening or assessment tools appears<br />
to be becoming more prevalent in managing patients<br />
at risk of/with pressure ulcers. These tools require to be<br />
validated and reliable, and like general risk assessment tools<br />
should not replace clinical judgement. However the use of<br />
validated nutritional assessment tools may help to foster<br />
attention upon the need to consider nutrition when assessing<br />
vulnerability to pressure ulcer development.<br />
Nutritional status should be re-assessed regularly following<br />
an individualized assessment plan which includes an<br />
evaluation date. The frequency of assessment should be<br />
based upon the condition of the individual and should occur<br />
following specific events such as surgery and any development<br />
of infections or other catabolic processes likely to<br />
stress the nutritional status of the individual.<br />
REPORT FROM THE GUIDELINE DEVELOPMENT GROUP<br />
While looking at the individual patient the clinical judgement<br />
of appropriately trained health professionals may provide<br />
sound evaluations of probable nutritional status, it<br />
should be acknowledged that excess of body weight may<br />
mask nutritional deficiencies – for example morbidly obese<br />
individuals may still be malnourished.<br />
Nutritional intervention<br />
Where an assessment or screening of nutritional status indicates<br />
that malnutrition may be present, nutritional intervention<br />
should be considered. The primary goal of nutritional<br />
intervention is generally to correct protein-energy<br />
malnutrition ideally through oral feeding. When considering<br />
any limitations on normal food and fluid intake, consider<br />
the local environment such as ease of access to food,<br />
social and functional issues along with the texture of the<br />
diet. Changes in these aspects may encourage or facilitate<br />
increased oral intake. Overall the goal should be to consider<br />
the quality and energy-density of the food intake rather<br />
than its quantity. Considering fluid intake quantity is equally<br />
important as quality.<br />
Where enhanced normal feeding is not possible, protein-energy<br />
rich oral supplements may be considered (Recommendation<br />
1, B; Benati et al 2001, Bourdel-Marchasson<br />
et al 2000, Breslow et al 1993, Chernoff et al 1990, Delmi et al<br />
1990 ). The value of vitamin and trace element supplementation<br />
in pressure ulcer prevention is unclear (Recommendation<br />
1, B; Taylor et al 1974, ter Riet et al 1995).<br />
Where normal feeding and oral supplementation fail<br />
to resolve apparent malnutrition then other routes (for example<br />
tube-feeding) may be undertaken although the risks<br />
associated with these interventions should be considered.<br />
While the amount of supplementation required by individuals<br />
will vary, general guidance can be offered where<br />
an individual may require a minimum of 30-35 kcal per kg<br />
body weight per day, with 1 to 1.5 g/kg/day protein required<br />
and 1ml per kcal per day of fluid intake.<br />
Specific guidance on energy expenditure may be provided<br />
through the use of standard equations such as the<br />
Harris-Benedict or Schofield formulae although it is recommended<br />
that advice on their use and interpretation be<br />
sought from a dietician (where available) or the multidisciplinary<br />
care team.<br />
The success of nutritional intervention should be reviewed<br />
within the on-going regular nutritional assessments<br />
and may be indicated by outcomes such as increased weight<br />
or improved functional ability and/or enhanced healthrelated<br />
quality of life. Successful nutritional intervention<br />
may also be marked by a reduced incidence of new pressure<br />
ulcers and the healing of established pressure ulcers.<br />
Regular evaluation of the effects of nutritional interventions<br />
is required but it should be borne in mind that where<br />
individuals are malnourished the effects of feeding and/or<br />
supplementation may not be immediately apparent, probably<br />
because there first needs to be a restoration of already<br />
depleted reserves.<br />
Where patients have established pressure ulcers then a<br />
similar strategy of nutritional intervention should normally<br />
be considered (normal feeding, then oral supplements and<br />
finally tube-feeding) although the demands may be greater.<br />
There are a number of observations upon the role of nutri-<br />
Volume 5, Number 3, 2003 81
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
tional deficiencies and pressure ulcer healing that can be<br />
extracted from controlled trials – protein and calorie supplementation,<br />
along with the use of arginine, vitamins and<br />
trace elements with antioxidant effects appear to have a<br />
positive effect on healing (Recommendation 1, B; Benati et<br />
al 2001, Bourdel-Marchasson et al 2000, Breslow et al 1993,<br />
Chernoff et al 1990, Delmi et al 1990). The evidence for the<br />
value of ascorbic acid supplementation is equivocal (Recommendation<br />
1, B; Taylor et al 1974, ter Riet et al 1995) and<br />
the evidence for zinc supplementation is weak (Recommendation<br />
1, B; Norris 1971).<br />
Specific issues may need to be resolved if normal feeding<br />
is to be enhanced – for example control of wound odour,<br />
altered body image, pain associated with the pressure ulcer<br />
and loss of self-esteem because these issues can reduce nutritional<br />
intake.<br />
Where individuals present with severe pressure ulcers<br />
(Grades 3 and 4) then the multidisciplinary team should<br />
consider their basal energy expenditure and pay particular<br />
attention to the increased fluid loss through such wounds.<br />
The nutritional requirements of specific groups may be<br />
different from those outlined in these guidelines, for example<br />
the spinal cord injured.<br />
Nutritional assessment and intervention should of<br />
course be combined with all other appropriate interventions<br />
including pressure management.<br />
These guidelines have not addressed several specific issues<br />
– nutritional assessment and intervention in neonates and<br />
paediatrics, the role of parenteral nutrition and specific<br />
needs of individual patient groups such as the immunosuppressed,<br />
those with cancers, orthopaedic, trauma and<br />
surgical patients and those who have experienced burns.<br />
Pharmacological interventions such as the use of anabolic<br />
steroids also are not included.<br />
In all of the preceding recommendations regarding nutritional<br />
assessment and supplementation all decisions<br />
should be taken with regard to patient choice and in light<br />
of the overall goals of treatment.<br />
Education<br />
There is a requirement for all staff (including but not limited<br />
to health professionals, untrained staff, catering and<br />
porters) to be aware of the importance of nutrition and to<br />
understand their role in improving the nutritional status of<br />
patients. This education will range from the performance<br />
of nutritional screening and assessment, the preparation<br />
of attractive, appetizing meals and the delivery and presentation<br />
of meals dependent upon the needs of individual<br />
staff members. There is a need to establish a nutritional<br />
culture within healthcare prompting the appropriate availability<br />
and presentation of meals through to continuity of<br />
nutritional care across departments and care settings.<br />
Summary of recommendations<br />
The <strong>EPUAP</strong> recommends that as a minimum, assessment<br />
of nutritional status should include regular weighing of<br />
patients, skin assessment, documentation of food and fluid<br />
intake. Additional procedures including anthropometric<br />
measurements and laboratory tests may also be performed<br />
82<br />
although these may best be viewed as more advanced assessment<br />
techniques. Nutritional intervention should focus<br />
upon improving the individual’s intake of food and fluids –<br />
through consideration of the quality of what is offered along<br />
with removing physical or social barriers to its consumption.<br />
Nutritional supplementation may be considered where<br />
it is not possible to enhance the individual’s own consumption<br />
of food and fluids.<br />
References used in the development of this guideline<br />
American Society for Parenteral and Enteral Nutrition Board of<br />
Directors. Definition of terms used in ASPEN guidelines and<br />
standards. JPEN 1995;19:1-2.<br />
Benati G, Delvecchio S, Cilla D, and Pedone V. Impact on<br />
pressure ulcer healing of an arginine enriched nutritional<br />
solution in patients with severe cognitive impairment. Arch<br />
Gerontol Geriatr, 2001, 33 Suppl 1, 43–47.<br />
Bourdel-Marchasson I, Barateau M, Rondeau V, Dequae-<br />
Merchadou L, Salles-Montaudon N, Emeriau JP, Manciet G,<br />
and Dartigues JF. A multicenter trial of the effects of oral<br />
nutritional supplementation in critically ill older inpatients.<br />
GAGE Group. Groupe Aquitain Geriatrique d’Evaluation.<br />
Nutrition, 2000, 16(1), 1–5.<br />
Breslow RA, Hallfrisch J, Guy DG, Crawley B, & Goldberg AP.<br />
The importance of dietary protein in healing pressure<br />
ulcers. J Am Geriatr Soc, 1993, 41(4), 357–362.<br />
Chernoff RS, Milton KY, & Lipschitz DA. The effect of a very<br />
high protein liquid formula on decubitus ulcers healing in<br />
longterm tubefed institutionalised patients. J Am Diet Assoc,<br />
1990, 90, A–130.<br />
Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, and Bonjour<br />
JP. Dietary supplementation in elderly patients with fractured<br />
neck of the femur. Lancet, 1990, 335(8696), 1013–16.<br />
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S,<br />
Mendelson RA and Jeejeebhoy KN. What is subjective global<br />
assessment of nutritional status? J. Parenter. Enteral Nutr.,<br />
1987, 11: 8-13<br />
Gray-Donald K, Payette H, Boutier V. Randomized clinical trial of<br />
nutritional supplementation shows little effect on nutritional<br />
status among free-living frail elderly. J Nutr 1995; 125(12):<br />
2965-71<br />
Green CJ. Existence, causes and consequences of disease related<br />
malnutrition in the hospital and the community, and clinical<br />
and financial benefits of nutritional intervention. Clinical<br />
Nutrition 1999;18(Supp 2):3-28.<br />
Keele AM, Bray MJ, Emery PW et al. Two phase randomized<br />
controlled clinical trial of postoperative oral dietary<br />
supplements in surgical patients. Gut 1997;40:393-399.<br />
Langer G, Schloemer G, Knerr A, Kuss O, Behrens J. Nutritional<br />
interventions for preventing and treating pressure ulcers<br />
(Cochrane <strong>Review</strong>). In: The Cochrane Library, Issue 4, 2003.<br />
Chichester, UK: John Wiley & Sons, Ltd.<br />
Lipschitz DA, Mitchell CO, Steele RW et al. Nutritional evaluation<br />
and supplementation of elderly subjects participating in<br />
a ‘meals on wheels’ program. JPEN 1985;9:343-7<br />
Mathus-Vliegen EMH. Nutritional status, Nutrition and <strong>Pressure</strong><br />
<strong>Ulcer</strong>s. Nutrition in Clinical Practice 2001; 16:286-291.<br />
Norris JR & Reynolds RE. The effect of oral zinc sulfate therapy<br />
on decubitus ulcers. J Am Geriatr Soc, 1971, 19, 793–797.<br />
Robinson G, Goldstein M, Levine GM. Impact of nutritional<br />
status on DRG length stay. JPEN 1987; 11: 49-52<br />
Taylor TV, Rimmer S, Day B, Butcher J, and Dymock IW.<br />
Ascorbic acid supplementation in the treatment of<br />
pressuresores. Lancet, 1974, 2(7880), 544–546.<br />
ter Riet G, Kessels AG, and Knipschild PG. Randomized clinical<br />
trial of ascorbic acid in the treatment of pressure ulcers. J<br />
Clin Epidemiol, 1995, 48(12), 1453–1460.<br />
The <strong>EPUAP</strong> would suggest that a sound starting point for further<br />
exploration of the links between nutrition and pressure<br />
ulcers would be the publication:<br />
Mathus-Vliegen EMH. Nutritional status, Nutrition and <strong>Pressure</strong><br />
<strong>Ulcer</strong>s. Nutrition in Clinical Practice 2001; 16: 286-291.<br />
Volume 5, Number 3, 2003
epuap<br />
WELCOME TO TAMPERE<br />
Opening speech by Kati Myllymäki<br />
THE <strong>EPUAP</strong> Open Meeting held in Tampere during<br />
September 2003 was officially opened by Kati<br />
Myllymäki. The following text reproduces her opening<br />
address to the meeting and the <strong>EPUAP</strong> would like to<br />
thank Kati and all our Finnish colleagues for their hospitality<br />
and warm welcome in Tampere.<br />
Distinguished experts, my dear colleagues and friends, ladies<br />
and gentlemen; it is my pleasure and honour to welcome<br />
you all to Tampere and to Finland for this meeting of<br />
the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>.<br />
The topic of this conference – <strong>Pressure</strong> <strong>Ulcer</strong> Prevention<br />
and Management is of the utmost importance. This<br />
area poses many challenges when I look at it with the eyes<br />
of a general practitioner in elderly care. We are trying to<br />
alleviate suffering of our patients when we first fail in prevention<br />
and after this first failure difficulties continue if<br />
their care and treatment is not appropriate. And when these<br />
problems accumulate and when problems stretch, the waiting<br />
lists to specialized care may be unreasonably long.<br />
With the eyes of administrator or even as a tax-payer we<br />
see that a focus upon the wrong issues – such as impaired<br />
rehabilitation, shortages of devices for the paralysed and<br />
immobile, a lack of hospice personnel and out-dated professional<br />
knowledge lead to increasing expenses, hospitalisation<br />
and great human suffering.<br />
It is delightful to see that the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong><br />
<strong>Advisory</strong> <strong>Panel</strong> is working hard to develop deeper understanding<br />
and evidence-based knowledge of this problem,<br />
and also is striving to spread this information to all professionals<br />
working in this field.<br />
In recent World Health Organization meetings the<br />
health ministers of the world have noted that an intersectoral<br />
approach to prevention strategies involving partnerships<br />
with communities, nongovernmental organizations,<br />
local government and private sector organizations (such as<br />
the <strong>EPUAP</strong>) is of utmost importance. In this field we do<br />
need to foster public awareness and responsible attitudes<br />
of all social and health professionals and decision-makers.<br />
As I am working for the Finnish National Health Care<br />
Project for our Ministry of Health, I must say a few words<br />
about money – the costs of health care. Globally we see that<br />
the rapidly changing age structures of many populations<br />
will lead to changing risk profiles in the coming decades.<br />
National social and health care services are challenged by<br />
aging populations, increasing health care costs and – luckily<br />
– also by improving medical technology.<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Open Meeting, Tampere, Finland 2003<br />
This Spring, the WHO general assembly unanimously<br />
accepted the Framework Convention on Tobacco Control<br />
and I am sure this expert audience here is very well aware<br />
of the effect of smoking on our skin’s blood circulation and<br />
the ability of our tissues to heal and recover when lacking<br />
oxygen. I wish that as health professionals you can also keep<br />
this congress smoke-free!<br />
A diabetes epidemic is also underway. As the number of<br />
people with diabetes grows worldwide, the disease takes an<br />
ever-increasing proportion of national health care budgets.<br />
Without primary prevention, the diabetes epidemic will<br />
continue to grow. Even worse, diabetes is projected to become<br />
one of the world’s main disablers and killers within<br />
the next twenty-five years. Immediate action is needed to<br />
stem the tide of diabetes and to introduce cost-effective treatment<br />
strategies to reverse this trend. An estimated 30 million<br />
people world-wide had diabetes in 1985. The latest<br />
WHO estimate (for the number of people with diabetes,<br />
world-wide, in 2000) is 177 million. This will increase to at<br />
least 300 million by 2025 – that is only 20 years from now!<br />
And you surely know what diabetes does to vulnerability to<br />
skin problems and ulcers.<br />
Ladies and gentlemen, we all know that prevention of a<br />
health problem is usually the cheapest option. On the other<br />
hand it is often the most difficult. From the time of Hippocrates<br />
to our own time and World Medical Association<br />
declarations: prevention is our ethical obligation. It is unfortunate<br />
that health care budgets or fee-for service systems<br />
seldom reward preventive work. Prevention is a major<br />
task for both health care professionals and experts in education,<br />
ordinary citizens and of course political decisionmakers.<br />
To tackle the great risk factors of ageing population<br />
(osteoporosis, hip-fractures, over-weight, diabetes,<br />
smoking, strokes) we need to change our own living habits.<br />
It will be much more expensive to respond to these challenges<br />
with pharmaceuticals, surgical operations and technological<br />
device when complications already exist.<br />
On behalf of the Ministry of Social Affairs and Health<br />
in Finland I wish you all an enjoyable stay in Tampere and a<br />
successful meeting. I am sure that all health care professionals<br />
and all our patients look forward to the information<br />
and advice you will provide for us.<br />
And I wish that you will also have the opportunity to<br />
take care of your personal mental and physical and social<br />
well-being – prevention or health promotion – while staying<br />
in this beautiful city.<br />
Volume 5, Number 3, 2003 83
FEBRUARY 2004<br />
15 Oxford International Wound Healing<br />
Federation Meeting<br />
Baroda, India<br />
Contact: oxfordwound@aol.com<br />
16 Oxford International Wound Healing<br />
Federation Meeting<br />
Pramumukhswami Medical College, and Sri<br />
Krishna Hospital, Karamsad, India<br />
Contact: oxfordwound@aol.com<br />
MARCH 2004<br />
12 – 13 The Different Aspects of the Venous Leg <strong>Ulcer</strong><br />
Copenhagen Wound Healing Center<br />
Bispebjerg University Hospital<br />
Copenhagen, Denmark<br />
Contact: www.cwhc.dk<br />
MAY 2004<br />
2 – 5 17th Symposium on Advanced Wound Care<br />
Disney’s Coronado Springs Resort<br />
Orlando, Florida, USA<br />
Contact: www.woundcaresymposium.com<br />
84<br />
epuap<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Future Meetings<br />
JUNE 2004<br />
9 – 12 49th Annual Meeting of the Plastic Surgery<br />
Research Council<br />
Ann Arbor, Michigan, USA<br />
Executive Office: 45 Lyme Road<br />
Suite 304, Hanover,<br />
NH 03755, USA<br />
JULY 2004<br />
8 – 13 2nd World Union of Wound Healing Societies<br />
Meeting · Paris, France<br />
MF Congress, Contact: Mr Bia<br />
8 rue Tronchet, 75008 Paris, France<br />
Tel: +33 140 07 11 21 Fax: +33 140 07 10 94<br />
Web: http://www.wuwhs.org<br />
Volume 5, Number 3, 2003
epuap News<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
from the Business Office<br />
DIRECTORS’ REPORT AND FINANCIAL STATEMENT<br />
For the Year Ended 30 June 2003<br />
Report of the Charity<br />
The activity over the last year has continued to expand on<br />
the previous years work to reflect the Charity’s objective ‘to<br />
provide the relief of persons suffering from, or at risk of<br />
pressure ulcers in particular through research and education<br />
of the public’. The <strong>EPUAP</strong> <strong>Review</strong>, the charity’s journal<br />
has been published three times and the <strong>EPUAP</strong> website<br />
(www.epuap.org) has expanded. The dissemination of<br />
knowledge on the prevention and management of pressure<br />
ulcers is provided daily through our Business Office by supplying<br />
the <strong>EPUAP</strong> guidelines as well as forwarding questions<br />
from our website to relevant experts in the field.<br />
Our very successful annual meeting was held in Budapest,<br />
Hungary in September 2002 with its theme: <strong>Pressure</strong><br />
ulcers – a quality of care indicator? As in previous years the<br />
quality of the scientific programme was excellent as well as<br />
challenging. Preliminary results from the Pan <strong>European</strong> <strong>Pressure</strong><br />
<strong>Ulcer</strong> Study were given by Christina Lindholm’s group<br />
and the new Dutch pressure ulcer guidelines were presented.<br />
The results of the <strong>EPUAP</strong>’s Prevalence Survey were also presented<br />
by Tom Defloor. The <strong>EPUAP</strong> subsidised a number of<br />
Eastern <strong>European</strong> medical professionals to attend the meeting<br />
and also to present their work to further our mission<br />
statement. The Lifetime Achievement Award was presented<br />
to Professor J. Barbanel from Scotland a well known and<br />
stimulating figure in the field of pressure ulcers.<br />
We were saddened at the death of a founding trustee<br />
and our first Recorder, Professor Gerry Bennett of London,<br />
who enriched the panel with his enthusiasm and expertise<br />
which contributed greatly to the success of our charity. He<br />
instituted a working party following last year’s annual meeting<br />
on nutrition and pressure ulcers which led to a major<br />
unconditional educational grant from Nutricia to develop<br />
guidelines on this important aspect of pressure ulcer management.<br />
The charity did recognise him last year in Budapest<br />
by acknowledging his contribution to the <strong>EPUAP</strong>. Following<br />
Gerry’s death Michael Clark assumed the chair of<br />
this working group and has since had two meetings which<br />
have resulted in the draft of preliminary nutritional guidelines.<br />
This draft will be presented at the Annual Meeting in<br />
Tampere in September 2003 for suggestions and criticisms<br />
from members of the <strong>EPUAP</strong>.<br />
A Trustees Meeting weekend was held on March 22–23,<br />
2003 with the majority of Trustees being present. The meeting<br />
was moderated by Keith Harding, the first President of<br />
<strong>EPUAP</strong>.<br />
Dr George Cherry<br />
The purpose of the meeting was to make an action plan<br />
for the future growth of the <strong>EPUAP</strong>. Although the Open<br />
meeting in Budapest was a huge success it was thought that<br />
there was still a perception that the <strong>EPUAP</strong> was a closed<br />
society, despite having 350 paying members and it was decided<br />
that we needed to market the panel to increase both<br />
awareness of the public and funding. Four groups had been<br />
identified at a previous Trustees Brainstorming meeting in<br />
January 2002:<br />
1. Administration – chair Jacqui Fletcher<br />
The purpose of this group was to identify the means<br />
of streamlining the administration of the <strong>EPUAP</strong> and<br />
also to note the qualities of all present trustees. It was<br />
decided to keep an accurate register of all details<br />
related to trustees and that a criteria of entry as a<br />
trustee should be formulated. This has now been<br />
completed and will be presented at the next Annual<br />
General Meeting for ratification by members of the<br />
panel.<br />
2. Education – chair Sue Bale<br />
It was thought that much research had been undertaken<br />
by the panel in the past two years. Such as the<br />
prevalence, PEPUS and support surface studies, but<br />
education of the public now needed to be seriously<br />
addressed. Courses for patients, carers and health<br />
care workers were to be organised at three levels,<br />
simple, intermediate and advanced. It was suggested<br />
that a grading system with photographs should be put<br />
on the website to aid in the identification of classification<br />
of pressure ulcers. This has now been successfully<br />
initiated and CDs of this grading system will be<br />
Volume 5, Number 3, 2003 85
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
86<br />
distributed to all attendees at the September 2003<br />
meeting in Tampere Finland. Collation of educational<br />
material from all <strong>European</strong> countries is also ongoing.<br />
3. Activities – chair Michael Clark<br />
This group is responsible for activities within the<br />
<strong>EPUAP</strong> and the setting up of venues for annual<br />
meetings. Lists of working groups are also collated by<br />
this group.<br />
4. Profiling Chair – Gerry Bennett<br />
(Christina Lindholm assumed the chair when Gerry Bennett<br />
became ill).<br />
This group had not had a chance to meet and it was<br />
felt was completely dependent on other groups. We<br />
need to involve key members of the <strong>European</strong> Union<br />
and <strong>European</strong> Economic Community to again assist<br />
with publicity etc.<br />
At the Trustees meeting in Oxford in March considerable<br />
discussion was led by Carol Dealey and Jacqui Fletcher on a<br />
document which they drew up suggesting new requirements<br />
to qualify as a trustee of the <strong>EPUAP</strong>. Initially when the panel<br />
was formed and made into a charity the founders thought<br />
it important to include trustees from the majority of the<br />
EEC countries in order to live up to the ‘<strong>European</strong>’ aspect<br />
of the charity’s name. The new document stresses the importance<br />
of expertise in pressure ulcers as a requirement<br />
for being a trustee. However, it could be argued that we<br />
should expand this to other individuals such as patients or<br />
people who have proven administrative abilities that would<br />
continue the success of the <strong>EPUAP</strong>. The changes for requirements<br />
to be a trustee will be discussed at our Annual<br />
General Meeting in Tampere Finland in September 2003<br />
for ratification.<br />
The <strong>EPUAP</strong> funded its President-elect Denis Colin to<br />
attend the meeting of our sister organisation NPUAP in<br />
New Orleans, USA.<br />
George Cherry who had been contacted several times<br />
by the press for information on pressure ulcers and the late<br />
Gerry Bennet who was leader of the ‘Elder Abuse’ charity<br />
decided that more publicity was needed to highlight this<br />
huge problem in Europe. The results of our <strong>European</strong><br />
prevalence study on pressure ulcers was given to the press<br />
by Michael Clark following press inquiries to the Business<br />
Office. This resulted in press and radio publicity.<br />
In order to meet the mission statement regarding public<br />
awareness a special publicity meeting was held in Oxford<br />
in March to draw up plans on how to increase the awareness<br />
of pressure ulcers in UK as in other countries such as<br />
the Netherlands and Sweden this has already been addressed.<br />
We were fortunate again that Hilary Scott from<br />
the Complaints and Clinical Negligence Office for the NHS<br />
was able to be present and share her knowledge. In addition<br />
representatives from our corporate sponsors as well as<br />
specialised wound healing journals; The Journal of Wound<br />
care which was represented by the editor Deborah Glover,<br />
were present so that the <strong>EPUAP</strong> could utilise their professional<br />
experience.<br />
Following this meeting all Members of the British Parliament<br />
have now been circulated with the results of the<br />
<strong>European</strong> Prevalence survey carried out by the <strong>EPUAP</strong><br />
which indicates that one in five hospital patients may have<br />
pressure ulcers. The healing of these ulcers is costly and<br />
time consuming as well as giving the patient and in some<br />
cases his/her carers poor quality of life. We are in the process<br />
of circulating the <strong>European</strong> Parliament with these results.<br />
Early responses acknowledging receipt of this publicity<br />
information from British Members of Parliament including<br />
the Prime Minister have been received.<br />
One of the major roles of the Secretary/Treasurer since<br />
the <strong>EPUAP</strong> has been founded has been that of raising funds<br />
for the charity. These have mainly come from our corporate<br />
sponsors, annual meeting support from Industry, delegates<br />
fees and subscription fees for membership. With regard<br />
to the latter, as previously stated we have more than<br />
350 members whose renewal subscriptions and certificates<br />
of membership are processed through the Business Office.<br />
The success of this endeavour has come from the excellent<br />
support of the Business Office personnel, Jane Green and<br />
Christine Cherry. All of the <strong>EPUAP</strong> annual meetings have<br />
been organised through the Business Office. The revenues<br />
of these meetings are in the attached Charity Commission<br />
Report and accounts and because our financial year ends<br />
on June 30, so that the report can be circulated at the Annual<br />
General Meeting in September, the revenue from each<br />
meeting is carried over into the next financial year.<br />
The <strong>EPUAP</strong> Business Office continues to be an essential<br />
part of the structure of the <strong>EPUAP</strong>. Subscriptions for<br />
membership, Industry subscriptions and mailing lists are<br />
all co-ordinated as well as mailings for meetings, publication<br />
of the <strong>EPUAP</strong> <strong>Review</strong>, collation of data regarding working<br />
groups etc. Queries from the web regarding patients<br />
are sent to relevant trustees to the nearest destination of<br />
the patient’s home. The annual meeting is arranged from<br />
within the business office. This includes obtaining the programme<br />
from the scientific committee, liaising with the<br />
Recorder with regards to speakers, organising satellite meetings<br />
and arranging travel for invited speakers. It also entails<br />
making site visits to the proposed venues for the meetings.<br />
Next year the annual meeting will take place in Paris,<br />
France, 8–13 July 2004 as part of the 2 nd World Union of<br />
Wound Healing Societies’ meeting. The <strong>EPUAP</strong> is one of<br />
the four co-hosting societies which enables us to obtain a<br />
portion of the revenues from that meeting. The <strong>EPUAP</strong> is<br />
playing a major part in the organisation of the scientific<br />
programme where it pertains to pressure ulceration.<br />
The Trustees of the <strong>EPUAP</strong> are in the early stages of<br />
writing a book on the prevention and treatment of pressure<br />
ulcers which is being led by our president Marco<br />
Romanelli.<br />
In summary the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong><br />
continues to be successful in achieving its mission statement<br />
but still has considerable work to do as long as pressure<br />
ulcers continue to be a major economic and health problem.<br />
This report has been prepared in accordance with special<br />
provisions of Part VII of the Companies Act 1985 relating<br />
to small companies.<br />
Dr George W Cherry<br />
Secretary / Treasurer<br />
18 August 2003 BY ORDER OF THE BOARD<br />
Volume 5, Number 3, 2003
EUROPEAN PRESSURE ULCER ADVISORY PANEL CHARITY<br />
STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 30 JUNE 2003<br />
Nutricia<br />
Guidelines<br />
Note Restricted Unrestricted Unrestricted<br />
Fund Funds Funds<br />
2003 2003 Total 2002<br />
INCOME AND EXPENDITURE £ £ £ £<br />
Incoming Resources<br />
Subscriptions – individual – 15260 15260 10390<br />
corporate – 58468 58468 29912<br />
Conference Income 2. – 106121 106121 57067<br />
Interest Receivable – 697 697 1045<br />
Research and Grants 13992 – 13992 12000<br />
______ ______ ______ ______<br />
Total Incoming Resources 13992 180546 194538 110414<br />
–––––– –––––– –––––– ––––––<br />
Resources Expended<br />
Charitable Expenditure<br />
Nutricia Guidelines 3496 – 3496 –<br />
Committee Meetings – 6319 6319 7983<br />
Awards made – 28 28 158<br />
Prevalence Study Meetings – 520 520 5889<br />
Secretarial and Office Expenses – 39342 39342 19002<br />
Publication Expenses – 12130 12130 14359<br />
Conferences and Meetings Expenses 2. – 103379 103379 63036<br />
Computer Support – 3405 3405 1950<br />
Advertising – 516 516 –<br />
NPUAP Conference – 1313 1313 –<br />
Project Work – 534 534 –<br />
Attendance by overseas delegates – 1710 1710 –<br />
Accountancy – 1366 1366 1207<br />
Bank Charges – 1570 1570 1238<br />
Depreciation – 679 679 942<br />
Management and Administration of the Charity – 1928 1928 1000<br />
______ ______ ______ ______<br />
Total Resources Expended 3496 174739 178235 116764<br />
–––––– –––––– –––––– ––––––<br />
Net Incoming/(Outgoing) Resources 10496 5807 16303 (6350)<br />
Fund Balances brought forward – 16583 16583 22933<br />
______ ______ ______ ______<br />
Fund Balances carried forward 10496 22390 32886 16583<br />
The above represents the recognised gains and losses of the charity.<br />
REPORT FROM THE <strong>EPUAP</strong> BUSINESS OFFICE<br />
–––––– –––––– –––––– ––––––<br />
Volume 5, Number 3, 2003 87
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
BALANCE SHEET AT 30 JUNE 2003<br />
Note 2003 2002<br />
£ £ £ £<br />
Fixed Assets 3. 2225 2904<br />
Current Assets<br />
Cash at Bank 68552 46225<br />
Prepayments 4. 24237 9601<br />
______ ______<br />
92789 55826<br />
Current Liabilities<br />
Accruals and Deferred Income 5. (62128) (42147)<br />
______ ______<br />
Net Current Assets 30661 13679<br />
_____ _____<br />
Net Assets 32886 16583<br />
_____ _____<br />
Represented by:<br />
Restricted Fund 6. 10496 –<br />
Unrestricted Funds 7. 22390 16583<br />
_____ _____<br />
These financial statements have been prepared in accordance<br />
with the special provisions of Part VII of the Companies<br />
Act 1985 relating to small companies and the Financial<br />
Reporting Standard for Smaller Entities (effective June<br />
2002).<br />
The directors are satisfied that the company was entitled<br />
to exemption under subsection (1) of section 249A of<br />
the Companies Act 1985 and that members have not required<br />
an audit in accordance with subsection (2) of section<br />
249B.<br />
The directors acknowledge their responsibilities for:<br />
a) ensuring that the company keeps accounting records<br />
which comply with section 221; and<br />
b) preparing accounts which give a true and fair view of<br />
the state of affairs of the company as at the end of the<br />
financial year and of its profit or loss for the financial<br />
year in accordance with the requirements of section<br />
226, and which otherwise comply with the requirements<br />
of this Act relating to accounts, so far as<br />
applicable to the company.<br />
These financial statements were approved on behalf of the<br />
charity on 18 August 2003.<br />
Signed on its behalf by _______________________________<br />
88<br />
George Cherry – Secretary/Treasurer<br />
32886 16583<br />
______ ______<br />
NOTES TO THE ACCOUNTS FOR THE YEAR<br />
ENDED 30 JUNE 2003<br />
1. Accounting Policies<br />
The following accounting policies have been applied consistently<br />
in dealing with items which are considered material<br />
in relation to the charity’s financial statements.<br />
a) Company Status<br />
The charity is a company limited by guarantee. The<br />
members of the company are the trustees.<br />
b) Basis of Preparation<br />
The financial statements have been prepared under<br />
the historical cost accounting rules, and in accordance<br />
with the Charities SORP and the Financial<br />
Reporting Standard for Smaller Entities (effective<br />
June 2002).<br />
c) Income and Expenditure<br />
Income and Expenditure is accounted for on an<br />
accruals basis. Subscription income is apportioned<br />
over the period to which it relates.<br />
d) Tangible Fixed Assets<br />
Tangible fixed assets are stated at historical cost less<br />
depreciation. Depreciation is provided using the<br />
reducing balance basis at rates which reflect the<br />
anticipated useful lives of the assets and their estimated<br />
residual values:<br />
Office Equipment 15%<br />
Computer Equipment 331 /3%<br />
Volume 5, Number 3, 2003
2. Annual Conference<br />
Income £<br />
From Corporate Sponsors 38495<br />
Satellite meeting 10500<br />
From individual registrations 52126<br />
From Convatec for programmes 5000<br />
______<br />
106121<br />
Less: expenditure (103379)<br />
______<br />
Surplus on Conference 2742<br />
3. Fixed Assets Office Computer<br />
Equipment Equipment Total<br />
£ £ £<br />
Costs:<br />
Brought Forward 2457 2823 5280<br />
Additions – – –<br />
_____ _____ _____<br />
Carried Forward 2457 2823 5280<br />
_____ _____ _____<br />
Depreciation:<br />
Brought Forward 883 1493 2376<br />
Charge 236 443 679<br />
_____ _____ _____<br />
Carried Forward 1119 1936 3055<br />
_____ _____ _____<br />
Net Book Value:<br />
As at 30 June 2003 1338 887 2225<br />
As at 30 June 2002 1574 1330 2904<br />
_____ _____ _____<br />
4. Prepayments<br />
Included within prepayments is an amount of £18,168 relating<br />
to expenses incurred for the Tampere Meeting being<br />
held in September 2003.<br />
5. Accruals and Deferred Income 2003 2002<br />
£ £<br />
Accountancy and Professional Fees 1300 1250<br />
Deferred Income 60828 40897<br />
_____ _____<br />
62128 42147<br />
_____ _____<br />
During the year subscriptions were received from individual<br />
members covering the subscription year ending 30 September<br />
2003 and corporate members covering the subscription<br />
year ending 31 December 2003. As these financial statements<br />
have been prepared to 30 June 2003 the element of<br />
subscriptions paid in advance at that date amounting to<br />
£43,604 has been treated as deferred income.<br />
REPORT FROM THE <strong>EPUAP</strong> BUSINESS OFFICE<br />
6. Restricted Fund<br />
This is a specific grant from Nutricia for the production of<br />
Nutritional guidelines<br />
7. Trustees Expenses<br />
Fifteen Trustees were reimbursed for their expenses,<br />
amounting to £25733 (2002 : £12976).<br />
ACCOUNTANTS’ REPORT<br />
ON THE UNAUDITED ACCOUNTS<br />
To the Members of the EUROPEAN PRESSURE ULCER<br />
ADVISORY PANEL CHARITY<br />
We report on the accounts for the year ended 30 June 2003<br />
set out above.<br />
Respective Responsibilities of Directors and Reporting<br />
Accountants<br />
As described above the trustees, who are also the directors<br />
of <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong> Charity for the<br />
purposes of company law, are responsible for the preparation<br />
of the accounts, and they consider that the company is<br />
exempt from an audit. It is our responsibility to carry out<br />
procedures designed to enable us to report our opinion.<br />
Basis of Opinion<br />
Our work was conducted in accordance with the Statement<br />
of Standards for Reporting Accountants, and so our procedures<br />
consisted of comparing the accounts with the accounting<br />
records kept by the company, and making such limited<br />
enquiries of the officers of the company as we considered<br />
necessary for the purposes of this report. These procedures<br />
provide only the assurance expressed in our opinion.<br />
Opinion<br />
In our opinion:<br />
a) the accounts are in agreement with the accounting<br />
records kept by the company under section 221 of the<br />
Companies Act 1985;<br />
b) having regard only to, and on the basis of, the<br />
information contained in those accounting records:<br />
(i) the accounts have been drawn up in a manner<br />
consistent with the accounting requirements specified<br />
in section 249C(6) of the Act; and<br />
(ii) the company satisfied the conditions for exemption<br />
from an audit of the accounts for the year<br />
specified in section 249A(4) of the Act and did not, at<br />
any time within that year, fall within any of the<br />
categories of companies not entitled to the exemption<br />
specified in section 249B(1).<br />
ABINGDON, OXON, UK Critchleys<br />
19 August 2003 Chartered Accountants<br />
Volume 5, Number 3, 2003 89
CLINICAL BENCH-MARKING – MAKING A<br />
DIFFERENCE THROUGH TEAM WORK<br />
Jackie Stephen-Haynes RGN DN DipH BSc(Hons) Masters in<br />
Clinical Nursing<br />
Lecturer and Practitioner in Tissue Viability for<br />
Worcestershire Primary Care Trusts and University College<br />
Worcester. Stourport Health centre, Worcester St, Stourport<br />
on Severn, Worcestershire. DY13 8EH Tel: 07775–792775<br />
Jackies_h@btopenworld.com<br />
Introduction<br />
The aim of this presentation is to highlight the constructive<br />
effect clinical benchmarking can have in making a difference<br />
to pressure ulcer prevention and management.<br />
Clinical benchmarking was defined as a process through<br />
which best practice is identified and continuous improvement<br />
pursued through comparison and sharing.<br />
Method<br />
A project was undertaken in the three Worcestershire Primary<br />
Care Trusts with representation from each of the six<br />
community hospitals and each of the nine areas within the<br />
county. Clinical benchmarking begins to challenge and legitimises<br />
the fundamentals of nursing practice. It does this<br />
by questioning our application of evidence-based healthcare<br />
‘what we know’ and ‘what we do’.<br />
To facilitate the implementation of benchmarking with<br />
a determination to improve clinical practice I have worked<br />
with the Institute of reflective practice utilising their colearning<br />
in practice as a framework to develop the team.<br />
We have undertaken a detailed understanding of the culture<br />
of the workplace and factors that assist or hinder them<br />
in taking practice forward, identified their own position in<br />
terms of taking practice forward in Tissue Viability, identified<br />
how it was possible to gain help from colleagues within<br />
the team.<br />
Results<br />
The team developed a mission statement; ground rules and<br />
audit tools based upon the clinical benchmarks. All team<br />
members have undertaken an audit of the 9 clinical benchmark<br />
factors within each community hospital and in each<br />
area of the community.<br />
The audits have clearly identified the areas for practice<br />
that can be improved and staff have acknowledged that some<br />
90<br />
epuap Poster<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Abstracts from Tampere<br />
7TH <strong>EPUAP</strong> OPEN MEETING, TAMPERE, FINLAND<br />
<strong>Pressure</strong> <strong>Ulcer</strong> Prevention and Management, Poster Abstracts, September 2003<br />
changes make more effective use of resources and that not<br />
all changes require extra funding.<br />
Each team has developed a Clinical-benchmarking<br />
folder of evidence, which includes National and local policy<br />
and guidelines, Clinical benchmarking audit tools, results,<br />
implications for practice, practical implementation, education<br />
and research, and patient information leaflet.<br />
Summary<br />
Together the team is utilising clinical benchmarking to take<br />
practice forward. A plan has been developed from both a<br />
strategic and practical implementation perspectives. The<br />
audit have demonstrated that we have made a difference in<br />
pressure ulcer prevention and management and key areas<br />
for future improvement have been identified.<br />
DEVELOPMENT OF AN EASY DECISION TREE<br />
FOR THE SELECTION OF A COMFORTABLE<br />
SUPPORT SURFACE WITHIN THE SCOPE OF<br />
THE GERMAN HEALTH SYSTEM FOR THE<br />
HOME CARE PATIENTS<br />
P Diesing, D Hochmann and U Boenick.<br />
Technical University of Berlin, Department if Biomechanical<br />
Engineering, Berlin, Germany<br />
Paticipants of the BVMed – Workgroup – U Gabler (ADL),<br />
A Bugs (Air-systems), H-J Flohr (Gerromed), E Goller (Hill-<br />
Rom), B Billen (ROHO), D Piossek (BV Med), P Diesing<br />
(TU Berlin)<br />
Introduction<br />
German law defines the rules supplying support surfaces to<br />
non-hospital patients with a high risk for pressure ulcer in<br />
the SGB V (Sozialgesetzbuch V). This law stipulates that for<br />
the reimbursement of the costs for a support surface, the<br />
product must be included in the German list of technical<br />
aids (Hilfsmittelverzeichnis), which was developed by the<br />
health insurances. The classification for this list is fixed by<br />
the organisation of the health insurances. The essential<br />
question, which support surface is the right one for which<br />
patient is not answered by this documentation.<br />
Because of a revision to this list, the companies selling<br />
those products have designed, under the leadership of the<br />
BVMed and the TU Berlin, a decision tree, a new classification<br />
and a glossary, which should help the health insurances<br />
to select the right support surface for the patient.<br />
Volume 5, Number 3, 2003
Methods<br />
The main idea behind the classification is that the decision<br />
for a support surface should be based on the risk of developing<br />
a pressure ulcer or on the risk that a pressure ulcer<br />
will not heal. It should not generally be based on the grade<br />
of an existing ulcer. This should help avoiding high costs<br />
with pressure ulcers by having an adapted prevention. The<br />
formal decision tree is based on the decision tree used in<br />
the USA for the last year. For the support surfaces, it is differentiated<br />
between:<br />
Mattresses vs. overlay<br />
Powered vs. non-powered devices<br />
Special features within the different groups.<br />
The decision tree and the decision rules are worked out<br />
in meetings with the companies AirSystems, ADL, Gerro-<br />
Med, Hill-Rom and ROHO. The responsible person from<br />
the BVMed and scientists from the TU Berlin also participated<br />
in this workgroup.<br />
Results<br />
As a result of this process, a decision tree was established<br />
with something similar to an instruction for use, a classification<br />
of support surfaces based on technical features of<br />
the products, and a glossary which defines and explains the<br />
products. This information is bundled in a brochure, which<br />
should be printed by the BVMed and should also be available<br />
on the Internet.<br />
The rules used for the decision tree could not be fixed<br />
by evidence-based medicine, but rather by the consensus<br />
of the clinical experience of the participants.<br />
Summary<br />
The presented classification is intended to lead in the direction<br />
of an evidence-based decision tree for support surfaces.<br />
However, with the currently existing studies it is not<br />
possible to define rules that allow an accurate evidencebased<br />
choice of a support surface.<br />
For the health insurance companies this decision tree<br />
allows to choose a product based on a clinical consensus.<br />
In the future the rules should be checked by several<br />
randomised trials.<br />
Contact: diesing@bmt1.kf.tu-berlin.de<br />
A NEW MODULAR TEST SYSTEM FOR THE<br />
MECHANICAL AND MICROCLIMATIC<br />
EVALUATION OF SUPPORT SURFACES<br />
P Diesing, D Hochmann and U Boenick.<br />
Technical University of Berlin, Department if Biomechanical<br />
Engineering, Berlin, Germany.<br />
Introduction<br />
The evaluation of the mechanical and microclimatic properties<br />
of support surfaces is important for various groups.<br />
The manufacturer wants to optimise his products for the<br />
best pressure relief and good microclimatic properties. The<br />
nurse in the hospital wants to know if a system works correctly<br />
with, for example, obese or heavily perspiring patients.<br />
The health insurances want to pay only for products that<br />
have a clinical effect. Due to the lack of clinical studies for<br />
all products in this field, these groups requested standard-<br />
POSTER ABSTRACTS FROM TAMPERE, 2003<br />
ised laboratory tests to predict the clinical effect of a system.<br />
In answer to this request, a project was initiated at the<br />
TU Berlin (funded by the Otto-Bock-Stiftung) to perform<br />
clinical tests, construct test equipment and try to correlate<br />
the results to a new test standard for support surfaces.<br />
Methods<br />
The main idea was to develop a test machine that is able to<br />
perform all necessary tests to characterize support surfaces.<br />
Due to its modular design, the machine can test both cushions<br />
and mattresses. The machine consists of a frame with a<br />
controlled driving unit and interchangeable modules for<br />
the different parameters. The modules should be designed<br />
for the mechanical and thermal stresses with pressure, shear,<br />
temperature and humidity. Those parameters should be<br />
controlled within physiologic and pathologic ranges. The<br />
modules are designed to be as simple as possible and should<br />
simulate the conditions of a human body in a standardized<br />
and reproducible way. The limit values have been acquired<br />
in clinical tests of geriatric patients. The effect of these experiments<br />
is detected by the same sensor that was used beforehand<br />
for the acquisition of the clinical data<br />
Results<br />
The test machine built worked as intended. An important<br />
feature is that the output of the machine could be adapted<br />
in a wide range to the requirements of the evaluation. Even<br />
though the conditions at the patient cannot be emulated<br />
in a completely physiological way, the resulting ranking was<br />
the same as in volunteer trials. The tests characterize the<br />
support surfaces in terms of their microclimate and mechanical<br />
properties. On the other hand, the first results<br />
showed that the standard deviation of these properties in<br />
this test procedure is much smaller than that of volunteer<br />
tests. This makes it much easier to create a reproducible<br />
standard for those tests.<br />
Summary<br />
The developed test machine increases the reproducibility<br />
of the evaluation results for support surfaces. The device<br />
can be easily adapted to different test procedures for different<br />
parameters. The use of the same sensors as in the clinical<br />
tests for microclimate and pressure mapping eliminates<br />
errors in the measurement technique. Based on the results<br />
of the clinical trial with geriatric patients, which should be<br />
finished at the end of the year, a classification for the different<br />
parameters should be adapted. This classification should<br />
improve the prediction of which support surfaces can improve<br />
the outcome of the patients.<br />
Contact: diesing@bmt1.kf.tu-berlin.de<br />
A CLINICAL EVALUATION OF THE KCI<br />
PROFICARE MATTRESS REPLACEMENT<br />
SYSTEM<br />
Fiona Collins<br />
Tissue Viability Consultancy Services Ltd, Eastbourne,<br />
England<br />
Introduction<br />
It is widely accepted that providing an appropriate pressure<br />
reliving mattress is essential for those people who are<br />
Volume 5, Number 3, 2003 91
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
very high risk or who have established pressure ulcer damage.<br />
The KCI Proficare Mattress Replacement System can<br />
provide both dynamic alternating and static pressure management<br />
and is intended to help prevent and manage pressure<br />
ulcers while optimizing comfort. It consists of 17 individual<br />
air cells which can be removed during treatment to<br />
optimize pressure relief, surrounded by a breathable waterproof<br />
two-way stretch cover.<br />
Method<br />
The aim of the clinical evaluation was to examine the effect<br />
of the KCI Proficare Mattress Replacement System on the<br />
healing of pressure ulcer damage. Five nursing home residents<br />
with established pressure damage consented to evaluate<br />
the Mattress over an eight week period. The wound(s)<br />
of each resident which were predominantly Grade 3 and 4<br />
(<strong>EPUAP</strong>, 2001) were photographed prior to the evaluation<br />
commencing. The resident’s existing mattress was replaced<br />
with a KCI Proficare Mattress Replacement System. The<br />
wounds were photographed on day two and thereafter<br />
weekly, for eight weeks. Medical and demographic information<br />
was obtained.<br />
Results<br />
The pressure ulcers in all of the residents demonstrated<br />
healing during the evaluation period, with one resident’s<br />
ulcer completely closing. One of the residents whose wound<br />
was making good progress died suddenly during week seven<br />
of the evaluation. All of the residents reported the mattress<br />
to be comfortable and staff comments concurred with this<br />
opinion. None of the mattresses suffered mechanical failure<br />
during the evaluation period.<br />
Summary<br />
This small evaluation would suggest that the KCI Proficare<br />
Mattress Replacement System can be effective at assisting<br />
in the healing of severe pressure damage in high-risk subjects.<br />
Furthermore, all of the residents who used the Mattress<br />
informally reported the mattress to be comfortable.<br />
Staff comments were also extremely positive.<br />
These results are encouraging, although it is unwise to<br />
draw any firm conclusions from such a small population. A<br />
larger study may be indicated in order to provide comparative<br />
evidence.<br />
References<br />
<strong>EPUAP</strong> (2001) <strong>Pressure</strong> ulcer classification.<br />
<strong>EPUAP</strong> Business Office. Wound Healing Unit.<br />
Department of Dermatology. Churchill Hospital. Oxford.<br />
www.epuap.org/gltreatment.hmtl<br />
PORTABLE NMR SPECTROSCOPY OF THE<br />
SOFT TISSUES: A NORMATIVE STUDY<br />
Duncan Bain, John Henton, Graham Nicholson and<br />
Martin Ferguson-Pell<br />
Centre for Disability Research and Innovation, University<br />
College London<br />
Introduction<br />
Technologies are now emerging to assist in the early identification<br />
of superficial pressure ulcers 1 . There is still a need<br />
92<br />
for diagnosis of pressure ulcers hat originate deeper in the<br />
tissues. Nuclear magnetic resonance (NMR) provides the<br />
potential for non-invasive examination of the tissues beneath<br />
the skin. Parameters relevant to pressure ulcers, such<br />
as ischaemia, oedema, and inflammatory responses, have<br />
previously been examined for other purposes using NMR.<br />
Alikacem et al 2 examined inflammatory responses to encapsulated<br />
foreign bodies using NMR, and found that certain<br />
NMR parameters correlated strongly with blood activation<br />
studies and histology. Klein 3 evaluated the viability of skin<br />
flaps using magnetic resonance spectroscopy. Richard et al 4<br />
examined age-related modifications of MRI parameters in<br />
the skin in vivo, relating the changes to structural deterioration.<br />
Physico-chemical and morphologic parameters of skin<br />
layers and subcutaneous tissue in the lymphedematous limb<br />
have been studied in vivo using magnetic resonance<br />
imaging 5 . Problems with this approach hitherto have been<br />
as follows: MRI is an expensive procedure, both in terms of<br />
capital and consumables. This limits not only its use for<br />
bulk data-gathering, but also its ultimate application as a<br />
routine screening tool for pressure ulcers.<br />
NMR spectroscopy, conversely, is much less expensive,<br />
but has historically only been suitable for in vitro samples,<br />
owing to the small size of available chambers. Recently, a<br />
mobile NMR device similar to a geological bore-hole probe<br />
has been developed for applications in materials science 6 .<br />
Using a small, hand-held probe incorporating permanent<br />
magnets, inhomogeneous polarising and radio-frequency<br />
magnetic fields are applied to arbitrarily large samples from<br />
one side. 7 To examine the usefulness of this technology for<br />
early identification of sub-dermal pressure ulcers, and for<br />
the characterisation of abnormal properties of soft tissues,<br />
a normative study was conducted to establish the range of<br />
values of NMR parameters that occur in normal tissues in<br />
different subjects, and in different parts of the body.<br />
Methods<br />
A hand-held permanent magnet surface coil was used to<br />
measure NMR parameters in the skin and underlying tissues<br />
of twenty healthy subjects. Measurements were made<br />
on the sacrum, buttocks, scapula, forearm, trochanter, and<br />
heels. T2 was measured at the surface, and at 5mm depth.<br />
Results<br />
Inter-subject variations in normal subjects are of lower order<br />
than intra-subject inter-body-site variations. The NMR<br />
map of the body may, therefore, be considered relatively<br />
generalisable for the normal population. T2 at 5mm depth<br />
was sensitive to body-fat, and correlated with body mass index.<br />
Earlier work indicates that NMR parameters in incipient<br />
pressure sores fall outside the range measured in normal<br />
subjects.<br />
Summary<br />
The applicants now propose to conduct an extensive study<br />
of the NMR parameters associated with pressure ulcers,<br />
compared with those of normal tissue. This process will<br />
generate a normative database, document the natural history<br />
of the pressure ulcer from an entirely unseen perspective,<br />
and identify possible strategies for prediction, early<br />
identification, and improved intervention decisions.<br />
Volume 5, Number 3, 2003
References<br />
1. Bain D, Ferguson-Pell M, Mcleod A: Skin evaluation<br />
apparatus. World patent WO0060349<br />
2. Alikacem N, Strman PW, Marois Y, Jakubiec B, Roy R,<br />
and Guidoin R. Non-invasive follow-up of tissue<br />
encapsulation of foreign materials. A magnetic<br />
resonance imaging and spectroscopy breakthrough.<br />
ASAIO J 1995 Jul-Sep; 41(3): M617–24.<br />
3. Klein HW, Gourley IM. Use of magnetic resonance<br />
spectroscopy in the evaluation of skin flaps. Ann Plast<br />
Surg Jun; 20(6):547-551<br />
4. Richard S, Querleux B, Bittoun J, Jolivet O, Idy-Peretti<br />
I, and de Lacharriere O, Characterisation of the skin<br />
in vivo by high resolution magnetic resonance<br />
imaging: water behaviour and age-related effects.<br />
5. Idy-Peretti I, Bittoun J, Alliot FA, Richard SB,<br />
Querleux BG, and Cluzan RV. Lymphedematous skin<br />
and subcutis: in vivo high resolution magnetic<br />
imaging evaluation. J Invest Dermatol 1998 May; 110(5):<br />
782–787.<br />
6. Blumich B, Blumler P, Eidmann G, Guthausen A,<br />
Haken R, Schmitz U, Saito K, and Zimmer G. The<br />
NMR-mouse: construction, excitation, and applications.<br />
Magn Reson Imaging. 1998 Jun–Jul; 16(5–6):<br />
479–84<br />
7. Zimmer G, Guthausen A, and Blumich B. Characterization<br />
of cross-link density in technical elastomers by<br />
the NMR-MOUSE. Solid State Nucl Magn Reson. 1998<br />
Sep; 12(2–3): 183–90.<br />
PRESSURE ULCER PREVENTION IN HOME<br />
HEALTH CARE – A DESC<strong>RIP</strong>TIVE STUDY<br />
Tom Defloor, Maggy Van Den Hel, Mieke Grypdonck,<br />
Nursing Sciences Ghent University, UZ Blok A, De<br />
Pintelaan 185, 9000 Gent, Belgium<br />
Introduction<br />
<strong>Pressure</strong> ulcers are a real problem in home health care,<br />
resulting in a high cost and human suffering. The aim of<br />
the study was to gain insight in the pressure ulcer prevalence<br />
in home health care and in the knowledge of nurses<br />
and their attitudes towards pressure ulcer prevention.<br />
Method<br />
Based on the Belgian pressure ulcer guidelines a pressure<br />
ulcer knowledge test was developed and validated by experts<br />
using a Delphi procedure. The attitudes towards pressure<br />
ulcer prevention were studied using a questionnaire.<br />
The <strong>EPUAP</strong> minimum data set was used to perform a pressure<br />
ulcer prevalence study.<br />
Sample<br />
All nurses (N = 174) working in a home health care organisation<br />
in East- and West-Flanders (Belgium) were asked to<br />
participate in the study and 112 participated; 547 patients<br />
from nine districts in East-Flanders were included in the<br />
prevalence study.<br />
Results<br />
The overall knowledge on pressure ulcers was low. Home<br />
health care nurses claimed that they mainly used their own<br />
POSTER ABSTRACTS FROM TAMPERE, 2003<br />
experiences to guide their preventive care. However, more<br />
than 50% of the nurses thought that the introduction of a<br />
prevention protocol would be useful or very useful. Journals<br />
are seldom consulted, except for those journals that<br />
are available in the office.<br />
The home health care nurses did not use a formal risk<br />
assessment scale. Their risk assessment was based mainly<br />
on the mobility and general condition of the patients.<br />
The home health care nurses could decide independently<br />
if preventive measures had to be taken and which preventive<br />
measures. Patient and family were consulted if the<br />
preventive measures had a major financial impact. The role<br />
of the family physician was not clear. He/she has a limited<br />
participation in the decision to start prevention. However,<br />
he/she was consulted when the preventive care had to be<br />
changed and that was conceived as a limitation of their care.<br />
The knowledge on the effectiveness of preventive measures<br />
was low. Their was also a discrepancy between the preventive<br />
measures that they thought to be effective and the<br />
measures they used in their own practice. Preventive measures<br />
with a limited effect were frequently used, more effective<br />
measures were seldom used. Financial and feasiblity<br />
concerns explained only partially this finding.<br />
The pressure ulcer prevalence was 7.5%; 1.2% of the atrisk<br />
patients received adequate preventive care.<br />
Conclusion<br />
The need of educational programs on pressure ulcer prevention<br />
and the development of evidence based protocols<br />
are immanent. It is important to take the attitudes towards<br />
prevention into account when protocols are developed and<br />
implemented.<br />
AN EUROPEAN PUBLIC TENDER FOR<br />
ANTI-DECUBITUS MATTRESS MATERIAL<br />
IN AN ACADEMIC HOSPITAL CENTER;<br />
A CHALLENGING PROCESS<br />
F. Heule (1,2) , D. van der Eijk (1,2) , Alexander Doeff (3)<br />
(1) Dept. of Dermatology, (2) Local <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong><br />
<strong>Panel</strong> (PUAP), (3) Dept. of Purchasing, Erasmus Medical<br />
Center, PO box 2040, Room H-897, 3000 CA, Rotterdam,<br />
The Netherlands.<br />
Introduction<br />
<strong>European</strong> rules dictate an <strong>European</strong> Public Tender (EPT)<br />
procedure for deliverance of goods or services with a value<br />
of Euro 249,000 and over. For all pressure ulcer preventive<br />
or curative (p/c) mattress material on a rental basis an average<br />
sum of Euro 450,000 in Erasmus MC, a 1300 bed hospital,<br />
is spent annually. Therefore, it was decided to start an<br />
EPT procedure.<br />
Material and methods<br />
The local PUAP and the Department of Purchasing worked<br />
together to make an overview of needs and wishes regarding<br />
product type, quality and management aspects. It was<br />
our goal to select a small gamma of products for a fair price<br />
from one or two trustful external partners. In three boxes<br />
low, middle and high-class p/c mattress material was discerned.<br />
In a matrix model standardised quality criteria were<br />
summarised, interface pressure measurements being a re-<br />
Volume 5, Number 3, 2003 93
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
search spearhead activity in our center, was a major citerium,<br />
and linked to a point qualification system. Also for purchasing<br />
aspects, deliverance estimates and subscription of a basic<br />
contract were credited with points.<br />
Results<br />
After six months the formula were ready. After publication<br />
of the EPT procedure in the <strong>European</strong> electronic pathway<br />
for these announcements, five companies subscribed, all<br />
of them having a basis in the Netherlands. The offered material<br />
was unevenly spread over the boxes. Answering of the<br />
criteria was often inaccurate. In general the material for<br />
documentation (like brochures) of products was of low<br />
quality; outdated and partly in a foreign language (English).<br />
The information on the most important aspect, i.e.,<br />
pressure relief capability was limited and inadequately sustained.<br />
Pricing was competitive, certainly in view the previous<br />
package. The total of points has resulted in the choice<br />
of two (potential) partners for the three boxes. However,<br />
one of them appeared not to be able to realise the offered<br />
quality and prices, and dropped out. The second in row<br />
was then invited and, after further discussions, the deals<br />
were confirmed. The total new set of p/c mattress material<br />
will now be introduced in the hospital.<br />
Summary<br />
The first EPT in the Netherlands of special mattresses for<br />
the prevention and treatment of pressure ulcers has been a<br />
learning experience both for the companies as for the decision-makers<br />
in the hospital. It was a time consuming and<br />
nerve tracking process in spite of the preparation work. Key<br />
words like professionally, teamwork, and fair play are relevant<br />
in this complex project. An evaluation of this obligatory<br />
EPT procedure is warranted. Time will show if it is rewarding.<br />
Reference<br />
Schofield T. Producing criteria for static mattress tender<br />
and purchase. J Woundcare 2001; 10(3): 77–9.<br />
PRESSURE ULCERS IN THE PERIOPERATIVE<br />
ENVIRONMENT: THE RESEARCH EVIDENCE<br />
‘… the operating table, [is] where so many so-called “postoperative”<br />
pressure sores originate’ (Norton, 1967)<br />
‘theatre tables and trolleys are probably the root case of a large<br />
proportion of pressure sores in surgical areas’ (Waterlow 1996)<br />
Eileen M Scott RGN, BA(Hons), MLitt, PhD<br />
Research and Development Co-ordinator, and Nurse<br />
Researcher, North Tees and Hartlepool NHS Trust,<br />
Stockton-on-Tees, TS19 8PE, England, UK<br />
The above comments illustrate the received wisdom that the<br />
operating theatre is a high risk area. They are the words of<br />
prominent British nurses – Doreen Norton and July Waterlow<br />
– whose views have the authority of the ‘expert’ on pressure<br />
ulcers.<br />
This paper, which is based on the author’s doctoral thesis<br />
(Scott 2000) will provide a review of the existing research<br />
evidence, from the 1970s to the current day. Key areas are:<br />
Risk assessment<br />
94<br />
Effects of anaesthesia and surgical trauma<br />
Inequalities of risk<br />
Duration and intensity of pressure<br />
The main findings will be summarised and areas where<br />
further research is needed will be identified.<br />
References<br />
Norton D (1967), Preventing lesions of the pressure<br />
areas, Nursing Mirror (14th July) 341–343.<br />
Scott E M (2000), Hospital acquired pressure sores in surgical<br />
patients. Unpublished PhD thesis, University of<br />
Teesside, UK.<br />
Waterlow J (1996), Operating table. The root cause of<br />
many pressure sores? British Journal of Theatre Nursing 6<br />
(7) 19–21.<br />
DISABILITY – PRESSURE SORE PREVENTION<br />
– A MULTIDISCIPLINARY APPROACH<br />
Margaret Ryan RGN RSCN, Maria Collins, Head of Nursing<br />
Department, CRC<br />
Nursing Department, Central Remedial Clinic, Vernon<br />
Avenue, Clontarf, Dublin 3, Ireland<br />
Introduction<br />
The Central Remedial Clinic (CRC) is a national organisation<br />
for the care, treatment and development of children<br />
and adults with physical and multiple disabilities. In 2002,<br />
a nurse-led <strong>Pressure</strong> Management Committee was formed<br />
with the remit of developing a multidisciplinary, multifaceted<br />
approach to pressure ulcer prevention and management.<br />
Nurse leaders coordinate the services of a multidisciplinary<br />
team including medical consultancy, seating and<br />
assistive technology, physiotherapy, occupational therapy,<br />
dietetics, social work and psychology.<br />
Objectives<br />
• The utilisation of all available resources to achieve a<br />
reduction in the incidence of pressure ulcers.<br />
• To devise a multidisciplinary approach to pressure<br />
ulcer prevention.<br />
• To reduce the personal and economic cost of pressure<br />
ulcer treatment.<br />
Methods<br />
• Nursing assessment of risk factors.<br />
• Coordination of multidisciplinary team/services, ie,<br />
utilisation of pressure monitoring system through<br />
seating/assistive technology.<br />
• Mobilisation of relevant treatment/services.<br />
• Implementation of planned and sustained programme<br />
of action.<br />
Result<br />
• An improved quality of life for our clients.<br />
• A more cost effective use of clinical resources.<br />
Summary<br />
Primary indicators of this prospective programme of pressure<br />
prevention, which is still in its infancy, promise a reduction<br />
in pressure ulcers through this multidisciplinary<br />
approach.<br />
Volume 5, Number 3, 2003
PADS AND PRESSURE: AN INVESTIGATION<br />
INTO THE EFFECTS OF ABSORBENT<br />
INCONTINENCE PADS ON PRESSURE<br />
MANAGEMENT MATTRESSES<br />
Fader M, Bain D, Cottenden A.<br />
Continence Technology Group, Departments of Medicine/<br />
Medical Physics and Bioengineering; Tissue Viability<br />
Research Unit, Centre for Disability Research and<br />
Innovation, University College London, England<br />
Introduction<br />
<strong>Pressure</strong> ulcers and incontinence often co-exist. 1 Urinary<br />
incontinence has been found to be a significant risk factor<br />
for pressure ulcers2 and there is a strong association between<br />
poor mobility and continence problems. 3 Patients<br />
using pressure management products are therefore also<br />
likely to be using absorbent pads but the effect that pad<br />
wearing has on pressure-relieving products is unknown. The<br />
aim of this study was to determine the effects that absorbent<br />
pads have, in both dry and wet states, on the pressurerelieving<br />
properties of standard and pressure management<br />
mattresses.<br />
Methods<br />
An instrumented articulated anthropometric phantom (Patent<br />
IPC 94928968.0) with simulated soft body ‘tissues’ in<br />
the gluteal and sacral areas was used as the ‘subject’. The<br />
soft tissues of the pelvic region are a silicone polymer compound<br />
with the same mean instantaneous static hardness<br />
value as the buttock tissues of a cohort of elderly volunteers<br />
(mean age 68.2 years, SD 3 years) 4 . The silicone compound<br />
was moulded in a CNC-generated mould representing the<br />
shape derived from numerical topography data acquired<br />
by laser scanning the same cohort of volunteers. The phantom<br />
is fixed on a ceiling-mounted guidance system for positioning<br />
on different surfaces. The phantom produces<br />
reproducible pressures (co-efficient of variation around 2%)<br />
compared to humans and is the method recommended by<br />
the <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong> (<strong>EPUAP</strong>) for<br />
testing pressure management products. 5<br />
A commonly used, commercially available absorbent pad<br />
and pant system for moderate to heavy incontinence was<br />
selected (Tena Comfort Super, SCA Hygiene Products AB,<br />
Göteborg, Sweden). This was tested with three different<br />
mattresses: (A) a standard foam mattress, (B) a visco-elastic<br />
(VE) foam mattress and (C) a surface-cut VE foam mattress.<br />
Mattresses (B) and (C) are marketed as pressure management<br />
mattresses. The phantom was raised and lowered<br />
onto the three mattresses in three states: naked, wearing a<br />
dry pad and wearing a wet pad following a standard operating<br />
protocol. The pressure mapping device Xsensor version<br />
4 (Xsensor Technology Corporation, Calgary, Canada)<br />
was used to record the distribution of pressure over the sacral<br />
and ischial areas of the phantom. Peak pressure was used<br />
as the primary outcome variable and ten repeats were made<br />
on each mattress under each condition.<br />
Results<br />
The table below shows that presence of an incontinence<br />
pad between the patient and the support surface raises the<br />
peak pressure by around 20–25%, a difference which is likely<br />
POSTER ABSTRACTS FROM TAMPERE, 2003<br />
to be of clinical importance. Peak pressures frequently occurred<br />
over areas of pad folds. Additional testing showed<br />
that pads that were ‘smoothed’ by hand had significantly<br />
lower peak pressures than ‘unsmoothed’ pads.<br />
Summary<br />
This study demonstrated that absorbent pads have a substantial<br />
adverse effect on the pressure redistribution properties<br />
of mattresses. Pad folds appear to contribute to this<br />
effect. Absorbent pad manufacturers should consider engineering<br />
pads that minimize disruption to pressure management.<br />
Further examination of continence and pressure<br />
management products is necessary to establish optimum<br />
combinations.<br />
References<br />
1. Guralnik JM, Harris TB, White LR, Cornoni-Huntley<br />
JC. Occurrence and predictors of pressure sores in<br />
the National Health and Nutrition Examination<br />
survey follow-up. J Am Geriatr Soc 1988 Sep; 36(9):<br />
807–122.<br />
2. Spector WD, Fortinsky RH (1998), <strong>Pressure</strong> ulcer<br />
prevalence in Ohio nursing homes:clinical and facility<br />
correlates. J Aging Health 10(1) 62-80.<br />
3. Sgadari A, Topinkova E, Bjornson J, Bernabei R.<br />
Urinary incontinence in nursing home residents: a<br />
cross-national comparison. Age Ageing 1997 Sep; 26<br />
Suppl 2: 49–54.<br />
4. Bain DS, Nicholson N, Scales JT. A phantom for the<br />
Assessment of Patient Support Systems. Med Eng &<br />
Phys. 21 (1999), 293–301.<br />
5. <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>, Working<br />
Group 2, Guidelines for the measurement and<br />
presentation of interface pressure data on support<br />
surfaces, January 2002.<br />
NOVARTIS HEALING SOLUTIONS – A TEAM<br />
APPROACH FOR PRESSURE ULCER WOUND<br />
CARE<br />
Posthauer, Mary Ellen, RD, LD, CD, CEO, M.E.P., Healthcare<br />
Dietary Services, Inc., Evansville, IN; Myer, Anne H., PT,<br />
GCS, CWS, Saddleback Coordinated Home Care, Laguna<br />
Hills, CA; Sussman, Carrie, PT, President, Sussman<br />
Physical Therapy, Inc, and Wound Care Management<br />
Services, Torrance, CA; Aquino, Maria Paz, RN, BSN, ET,<br />
Clinical Consultant, Kinetic Concepts Inc., Germantown,<br />
MD; Baronoski, Sharon, MSN, RN, CWOCN, Joliet, IL;<br />
Lyder, Courtney H., ND, GNP, FAAN, Associate Professor and<br />
Director Adult Family, Gerontological and Women’s Health,<br />
Director, Program for the Advancement of Chronic Wound<br />
Care, Yale University School of Nursing, New Haven, CT;<br />
Thomas, David R., M.D., Professor, Saint Louis University<br />
School of Medicine, Division of Geriatric Medicine, St.<br />
Louis, MO.<br />
Objectives<br />
Bring together a team of multidisciplinary pressure ulcer<br />
subject matter experts to develop and prepare a evidencebased<br />
program to aide long term care clinicians in pressure<br />
ulcer prevention and treatment.<br />
Development of a practical educational guide for long-<br />
Volume 5, Number 3, 2003 95
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
term care built upon and supplementary to previously published<br />
materials.<br />
Facilitate the implementation of quality care measures<br />
for the prevention and treatment of pressure ulcers in long<br />
term care facilities.<br />
Introduction / Problem<br />
<strong>Pressure</strong> ulcers represent a complex clinical problem for<br />
which no ‘gold standard’ of prevention or treatment has<br />
been established. For the elderly, pressure ulcers can have<br />
serious consequences that may include lifestyle limitations,<br />
reduced self-esteem, altered body image, pain, delay in rehabilitation,<br />
and increased morbidity and mortality.<br />
Preventing skin breakdown and supporting the healing<br />
of existing pressure ulcers is a problem for caregivers of<br />
the geriatric population in long term care facilities.<br />
Methodology<br />
Constructed on evidence-based materials, a multidisciplinary<br />
panel of pressure ulcer subject matter experts developed<br />
an educational guide to implement a team approach<br />
of best practices for pressure ulcer prevention and<br />
treatment in the long term care setting.<br />
Results<br />
A set of fourteen overlapping decision trees for medical,<br />
nursing, nutrition, and physical therapy management were<br />
designed and produced. The decision trees provide a systematic<br />
approach to clinical problem solving including caveats.<br />
Each decision tree elaborates on its components and<br />
develops each discipline’s contribution to overall care.<br />
Conclusion<br />
Fourteen overlapping decision trees form the package<br />
known as The Healing Solutions Program: a team approach<br />
for pressure ulcer wound care. The Healing Solutions program<br />
is scheduled to be launched in February of 2003. The<br />
goal is to have 25 national and regional facilities utilizing<br />
the program by the end of 2003. Plans include tracking<br />
outcomes to evaluate if and how the program changes clinical<br />
practice in long-term care facilities.<br />
EDUCATIONAL PROGRAMME FOR<br />
ASSISTANT NURSES ACCORDING TO<br />
<strong>EPUAP</strong> GUIDELINES<br />
Anna-Britta Tallberg R.N., Agneta Bergsten R.N.<br />
Wound Healing Centre, Department of Surgery, University<br />
Hospital, Uppsala, Sweden.<br />
Introduction<br />
An educational programme for registered nurses was developed<br />
and implemented in 1998 and repeated in 2001.<br />
These pressure ulcer nurses have been active in pressure<br />
ulcer prevention in their own units. Since pressure ulcer<br />
prevention is a multidisciplinary teamwork it was important<br />
to include assistant nurses in this work.<br />
Objectives<br />
To conduct an educational programme for assistant nurses<br />
working in different units in the university hospital, in nursing<br />
homes and home care units.<br />
96<br />
Method<br />
The educational programme was adjusted to assistant nurses<br />
and based on guidelines issued by the <strong>European</strong> <strong>Pressure</strong><br />
<strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>. The course consisted of twelve hours<br />
of theory (three afternoons) and practical tasks. For example,<br />
the participants should perform an inventory of routines<br />
for pressure ulcer prevention and dressings in their<br />
own units. Two nurses from the wound healing centre were<br />
course leaders together with two pressure ulcer nurses.<br />
Result<br />
The educational programme was held twice with thirty participants<br />
in each course. An evaluation showed that the participants<br />
were very satisfied.<br />
Conclusion<br />
The educational programme was successful. The number<br />
of candidates who applied to the courses was twice as many<br />
as there were places.<br />
INVESTIGATION OF THE MINIMUM SPATIAL<br />
RESOLUTION REQUIRED BY PRESSURE<br />
MAPPING SYSTEMS FOR SEATED PATIENTS<br />
Nicholson G, Elhusseiny A, Bain D, and Ferguson-Pell M.<br />
Centre for Disability Research and Innovation, University<br />
College London and ASPIRE, Brockley Hill, Stanmore<br />
Middlesex. HA7 4LP. g.nicholson@ucl.ac.uk<br />
Introduction<br />
Wheelchair users, particularly those with spinal injuries, are<br />
at significant risk of developing pressure sores. In order to<br />
assist clinicians in the evaluation and selection of suitable<br />
cushions the mapping of pressure distribution at the buttock/cushion<br />
interface is being increasingly used. The<br />
greater the number of sensors across the interface, or spatial<br />
resolution, the greater the chance of identifying changes<br />
in pressure, giving a more realistic representation of a person’s<br />
actual pressure distribution. Commercial pressure<br />
mapping systems vary greatly in the spatial resolution, and<br />
in order to make up for a lower spatial resolution manufacturers<br />
use interpolation. The aim of this study was to assess<br />
the influence of sensor spatial resolution on measured pressure<br />
values at a seated interface and a therapists’ ability to<br />
make subjective judgements from them.<br />
Methods<br />
<strong>Pressure</strong> distributions from ten spinal cord injured patients<br />
and ten able-bodied subjects were collected using a highresolution<br />
pressure mapping system (Tekscan, Boston, MA).<br />
The spatial resolution of these pressure distributions was<br />
degraded mathematically, and cubic spline interpolation<br />
applied to the degraded pressure distributions to give three<br />
pseudo levels of spatial resolution; Resolution 1, 40 x 40<br />
sensing elements (7 mm diameter) with 10mm spacing between<br />
their centres; Resolution 2, 20 x 20 sensing elements<br />
(7 mm diameter) with 20mm spacing between their centres<br />
and interpolated to 40 x 40; Resolution 3, 10 x 10 sensing<br />
elements (7 mm diameter) with 30mm spacing between<br />
their centres and interpolated to 40 x 40. The original and<br />
degraded–interpolated pressure distributions were scored<br />
by three occupational therapists and two rehabilitation en-<br />
Volume 5, Number 3, 2003
gineers in terms of obliquity, rotation, pelvic tilt and localisation<br />
of pressure. The pressure distributions were quantified<br />
in terms of peak pressure, average pressure, peak pressure<br />
index, localisation of pressure, and index gradient at<br />
peak pressure.<br />
Results<br />
Sensor repeatability was 2–3% between 50–200 mmHg, linearity<br />
2–5%, creep
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
They were originally used for characterising foam slabs and<br />
cushions that may be used by many people. They do not<br />
take into account conformability of the cushion nor the<br />
custom fit to an individual. The “fatigue” test produced<br />
only small changes in the cushions, raising the question<br />
whether they were really fatigued at all. Had more cushions<br />
of a single type been tested for inter-cushion reproducibility<br />
such differences may no longer have been of significance.<br />
A EXAMINATION OF THE EFFICACY OF THE<br />
CONTRACTURAL PAD FOR PRESSURE ULCER<br />
Makiko Tanaka, Miki Haruma, Maki Mimura and Kouji<br />
Kajiwara<br />
Yamaguchi Prefectural University School of Nursing,<br />
Yamaguchi, Japan. Molten Corporation, Hiroshima, Japan<br />
Introduction<br />
Through the questionnaire administered to 404 nurses in<br />
Japan, it was made clear that many nurses experience difficulty<br />
with positioning of patients with pressure ulcer. It was<br />
particularly noteworthy that while 84% of the nurses felt<br />
the necessity of the positioning as a care for contractural<br />
patients, they did not possess any effective methods. A pad<br />
for contractural patients was therefore devised; its effects<br />
are described in this paper.<br />
Method of Measurement<br />
Because it is not possible to generalize contracture, the<br />
upper body muscular contracture (the shoulder’s incycloduction,<br />
adduction, and upper arm pronation) often seen<br />
in clinical settings, was used as the standard contractural<br />
position. The contractural pad was made of perforated<br />
urethane foam with the cover having a perforated honeycomb<br />
structure. The body pressure dispersion effect and<br />
the humidity of this pad were examined when the pad was<br />
placed under the arm and when it was not.<br />
Conditions of Measurement<br />
The contractural standard position was simulationally assumed.<br />
Then the body pressure sensor and the humidity<br />
sensor were placed and a measurement for each was taken<br />
five times with one subject (female, BMI 19.0). As for the<br />
humidity, a measurement was taken after over one hour of<br />
continuous usage.<br />
Results<br />
The average body pressure when the contracture pad was<br />
not used, was 51mmHg, while the average when it was used<br />
was 28.6 mmHg, indicating a lower body pressure when the<br />
contractural pad was in use. As for the humidity, an examination<br />
of an approximate linear line showing the humidity<br />
change showed a larger slope when the pad was not used,<br />
indicating a marked increase of humidity. The humidity one<br />
hour after the beginning of the measurement was 71% when<br />
the pad was not used and 30.7% when it was used.<br />
Summary<br />
It may be concluded that the contractural pad under discussion<br />
was effective as a cushioning device to the body pressure<br />
and humidity.<br />
98<br />
STUDY OF FIVE BED MATTRESSES USING<br />
PRESSURE MAPPING AT 500-BED LONG-TERM<br />
CARE FACILITY<br />
Vern C. Taylor, P.T. Physical Therapist, Verg Inc., Winnipeg,<br />
Manitoba, Canada<br />
Beth Kondratuk, R.N., B.N., M.S.A, Clinical Nurse Specialist,<br />
Deer Lodge Centre, Winnipeg, Manitoba, Canada<br />
Introduction<br />
In North America, over 1.8 Million people develop ulcers<br />
annually, 1 which cost up to $1.3 Billion/year. 2 Prevalence<br />
is estimated at 11% in skilled-care and nursing homes, 10%<br />
in acute care, and 4.4% in home care. 3,4,5 Causes of these<br />
ulcers is multifactorial and include lowered sensory perception,<br />
immobility, incontinence/moisture, altered level of<br />
consciousness, poor circulation, severity of disease, and poor<br />
nutritional status. 6,7,8,4,9 Wound Care is expensive. The cost<br />
of treating one ulcer is reported to be from $5,000 to $60,000<br />
depending on stage of ulcer and patient condition. 10,11,12,13<br />
Long Term Care facilities have the challenge of caring for<br />
the chronically ill on a continuing basis. This group of patients<br />
is subject to pressure ulcers associated with their disabling<br />
condition. Nursing at these facilities must provide<br />
preventative management and heal existing wounds within<br />
a very limited budget.<br />
Methods<br />
This study assesses five bed mattress surfaces that range in<br />
cost from least expensive to the highest affordable price<br />
within the institutional budget. A multi-layered single case<br />
study design was used with a healthy 81-year-old volunteer<br />
that closely matched the average (age, gender, weight) of<br />
the patient population. The volunteer was positioned in four<br />
standard nursing positions used routinely in care at the facility.<br />
A Standard Hospital mattress was used first and last for<br />
each test series to provide a control. Multiple pressure maps<br />
were taken of each position, using a calibrated Force Sensing<br />
Array (FSA) pressure mapping system.[*] Results were<br />
collected and pressure distribution was compared for each<br />
position and all mattress surfaces using three methods:<br />
Sensor Count: defined as total number of sensors reading<br />
above a minimum threshold. This measure indicates how<br />
much contact is occurring with the patient in each position<br />
and each mattress type. This would indicate the amount of<br />
envelopment for each bed mattress.<br />
Peak Pelvic <strong>Pressure</strong> Row: the cross-sectional row of highest<br />
pressures identified at the pelvis region in each position<br />
for each surface was graphed and compared. This allowed<br />
the different surfaces to be compared on a single graph for<br />
the pressure row at the highest pressure point through the<br />
pelvis.<br />
<strong>Pressure</strong> Map Comparisons: the complete pressure map<br />
images were blinded to the type of surface and the readings<br />
for each nursing position were presented to the caregiving<br />
nurses for ranking (best to worst) in their judgment.<br />
The nurses were also asked to rate the comparative value of<br />
the pressure map based on the nurse’s perception of usefulness<br />
to their patient using a 0–5 scale. Five skilled wound<br />
care nurses and five regular duty nurses were used and these<br />
results were then graphed separately and together for comparison.<br />
Volume 5, Number 3, 2003
Results<br />
Presented results demonstrate: Sensor Count, the most<br />
objective measure, showed Standard hospital mattress to<br />
be poorest in all positions but did not demonstrate much<br />
differentiation for other surfaces. Peak Pelvic <strong>Pressure</strong> Row<br />
graphing clearly demonstrated relative differences well<br />
which allowed good comparison of different surfaces for<br />
each position. <strong>Pressure</strong> Map comparisons by nursing staff<br />
showed good correlation amongst assessors and allowed for<br />
ranking and valuation of the surfaces under consideration.<br />
Summary<br />
Using a standardized assessment with a healthy volunteer,<br />
representative of patient population, with three review<br />
methods derived from pressure mapping proved very useful<br />
in understanding the relative value of the bed mattress<br />
surfaces under consideration by nursing. From this assessment<br />
a recommendation was compiled for mattress purchases<br />
for prevention and management of ulcers in the facility.<br />
It is hoped that this evidence based recommendation<br />
forwarded to administration for future mattress purchases<br />
would aid nursing to provide improved quality of care within<br />
a limited budget including prevention and healing of <strong>Pressure</strong><br />
<strong>Ulcer</strong>s in this Long Term Care Facility.<br />
[*]Verg Inc. manufactures the FSA <strong>Pressure</strong> Mapping System<br />
used in this study. The second author is a co-owner of<br />
the company and provided the technical equipment and<br />
assistance for this study.<br />
References<br />
1. POV Inc.(1998), Long term care: Evolving business<br />
opportunities and threats. Cedar Grove, NJ.<br />
2. Miller, H. and Delozier, J.(1994) Cost implications of<br />
pressure ulcer treatment guideline (pp. 1–17).<br />
Columbia, MD: Center for Health Policy Studies.<br />
CNo. 282–91–0070. Sponsored by HCP&R<br />
3. Barczak, C.A. et al(1997), Fourth National <strong>Pressure</strong><br />
<strong>Ulcer</strong> Prevalence Survey. Advances in Wound Care,<br />
10(4), 18–26.<br />
4. Brandeis, G.H., Berlowitz, D.R., Hossain, M., and<br />
Morris, J.N. (1995). <strong>Pressure</strong> ulcers: The minimum<br />
data set and the resident assessment protocol.<br />
Advances in Wound Care 8(6), 18–25<br />
5. Hallet, A.(1996), Managing pressure sores in the<br />
community. Journal of Wound Care 5(3), 105–107.<br />
References 6–13 were provided at the conference.<br />
STUDY ON PRESSURE ULCERS (PU), THEIR<br />
LOCATIONS AND PROTECTION MEASURES<br />
ON THREE INTENSIVE CARE UNITS OF THE<br />
ACADEMIC MEDICAL CENTER IN<br />
AMSTERDAM<br />
J.A. Tutuarima 1 , M.J. Lubbers 2 , J. Vorstermans 3<br />
1. Nurse researcher, Department of Neurosciences,<br />
2. Surgeon intensivist, Department of Surgery,<br />
3. Intensive care nurse, The Academic Medical Center,<br />
University of Amsterdam in Amsterdam, The Netherlands<br />
Introduction<br />
On the Intensive care units PU are a serious problem. High<br />
POSTER ABSTRACTS FROM TAMPERE, 2003<br />
percentage is usual. 1 The Dutch Institute for Healthcare<br />
Improvement (CBO) in Utrecht started a multi-center<br />
project to improve risk assessment, prevention, diagnosis<br />
and treatment of existing pressure ulcers. This study is part<br />
of the CBO project. The objective of this study is to determine<br />
the prevalence of pressure ulcers (PU) and of post<br />
surgical onset of PU as well as factors associated with PU<br />
and to assess the specific protection measures.<br />
Methods<br />
We designed an observational cohort study on 130 consecutively<br />
admitted patients in three adult intensive care units<br />
of a Dutch university hospital. The primary nurse daily inspected<br />
the presence of PU and assessed the protection<br />
measures with regard to prevention and healing of PU over<br />
a period of two months.<br />
Main results<br />
Of the patients 31% suffered from hospital acquired PU.<br />
Sacrum, ears and heels were most involved (15, 12 and 12%<br />
respectively), buttocks, mouth and back were affected in 5,<br />
4 and 4% respectively. All other nine locations were less<br />
involved. Post surgical assessment showed PU of the lip and<br />
fingers in one patient each, of the back of head in two cases,<br />
of the nose and mouth in three patients each, of the buttocks<br />
in five cases, and of the sacrum in nine patients. Cross<br />
tabulation on PU showed no association with gender age,<br />
post surgery and Apache II. All patients are positioned on<br />
active pressure relief mattresses. Extra protection measures<br />
were practised to 80% of the patients. Protection of heels<br />
and ears each to 60% of the patients, multiple turning position<br />
and protection of the skin to 43 and 38% respectively.<br />
Summary<br />
This observational study showed evidence based figures of<br />
PU and detailed locations and protection measures of an<br />
highly risk population of patients for PU in an acute care<br />
setting.<br />
Reference<br />
1. Bours GJ, De Laat E, Halfens RJ, Lubbers. M. Prevalence,<br />
risk factors and prevention of pressure ulcers in<br />
Dutch intensive care units. Results of a cross-sectional<br />
survey. Intensive Care Med. 2001 Oct;27(10):1599–1605.<br />
MEASURING THE PRESSURE AT ‘THICKENED<br />
EDGES’ AND ‘NORMAL EDGES’ OF A WOUND<br />
Mayumi Okuwa 1 , Hiromi Sanada 1 , Junko Sugama 1 ,<br />
Chizuko Konya 1 , Atsuko Kitagawa 1 , Yumiko Fujimoto 2 and<br />
Nao Tamai 3<br />
1. School of Health Sciences, Faculty of medicine, Kanazawa<br />
University, Japan. 2. Kobe City General Hospital, 3. St<br />
Luke’s International Hospital.<br />
Introduction<br />
The 30-degree lateral and 30-degree head-elevated positions<br />
are widely used in a clinical setting for patients with pressure<br />
ulcers to relieve the localized pressure on bony-prominent<br />
areas. A result of this positioning sometimes causes<br />
the perimeter regions of the pressure ulcer to thicken. This<br />
phenomenon is believed to be caused by increased pres-<br />
Volume 5, Number 3, 2003 99
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
sured on the perimeter of the wound. However, a new affixed<br />
sensor (by DENSO Ltd.) was developed to quantitatively<br />
measure the localized pressure around a wound. The<br />
purpose of this study was to use this device to measure the<br />
pressure on this thickened perimeter region and compare<br />
it with other local regions of a wound.<br />
Methods<br />
SENSOR SPECIFICATIONS<br />
Pad Material: 3 Polyethylene naphthalate (waterproof)<br />
sensor pads<br />
Pad Dimensions: diameter x thickness (5 mm x 0.3 mm)<br />
Recording Interval: 0.16 sec. (simultaneous recording of<br />
all three sensors) The reliability and validity of the sensor<br />
were confirmed.<br />
SUBJECTS<br />
The informed consent was received by the five bedfast patients<br />
(mean age 78.6) with pressure ulcer who participated<br />
in this study. In the perimeter of each wound thickened<br />
parts and normal (thickening-free) parts existed. The<br />
wounds were located at sacrum or coccyx.<br />
CONDITIONS AND MEASURING PROCEDURE<br />
The pressure of specific areas around the wound region<br />
for each patient was measured at thirty-minute intervals<br />
with the patients lying in both the 30° lateral and 30° headelevated<br />
positions. We measured the pressure of visibly thickened<br />
edges and normal edges of each wound.<br />
ANALYSIS<br />
We categorized our data into two groups. One representing<br />
‘thickened edges’ and the other representing ‘normal<br />
edges’. We then compared both the maximum pressure values<br />
as well as the average pressure values for each group by<br />
using the Wilcoxon test.<br />
Results<br />
Both the 30-degree lateral position and 30-degree head-elevated<br />
position showed that the maximum pressure as well<br />
as the average pressure of the ‘thickened edges’ was significantly<br />
greater than that of the ‘normal edges’.<br />
Conclusion<br />
Based on our results, we found that the pressure at the ‘thickened<br />
edges’ was greater than at the ‘normal edges’. Furthermore,<br />
we found that positioning patients in the 30° lateral<br />
or 30° head-elevated position may not decrease the local<br />
pressure of these areas. We need future research to confirm<br />
a relationship between the positioning and the physical<br />
characteristics in Japanese elderly.<br />
CLASSIFICATION OF HEALING PROCESS<br />
PATTERNS OF PRESSURE ULCERS WITH<br />
UNDERMINING FOR JAPANESE ELDERLY<br />
Chizuko Konya, Hiromi Sanada, Junko Sugama, Mayumi<br />
Okuwa and Atsuko Kitagawa<br />
School of Health Sciences, Faculty of Medicine, Kanazawa<br />
University, Japan<br />
Introduction<br />
Since there has been no reported research on the healing<br />
process for the conservative treatment of pressure ulcers<br />
100<br />
with undermining, the healing process of this type of pressure<br />
ulcer is unknown. The purpose of this study was to<br />
categorize pressure ulcers with undermining into patterns<br />
and to examine the healing process of each pattern. We<br />
also attempted to determine what type of nursing care and<br />
physical factors influenced the healing process of each pattern.<br />
Method<br />
This study involved 69 elderly patients (65 years old, or<br />
older) with Stage III or IV pressure ulcers. We examined a<br />
total of 79 pressure ulcers. Informed consent was obtained<br />
from all patients. Photographs of the pressure ulcers were<br />
taken and hand-sketched on a weekly basis. Based on these<br />
sketches, we described the healing process of each pressure<br />
ulcer. We then inductively classified and statistically<br />
compared the following criteria of each healing process<br />
pattern: the healing period, wound surface area, type of<br />
nursing care and various physical factors.<br />
Results<br />
Of the 79 pressure ulcers, 57% were undermining. Based<br />
on the pressure ulcer healing process (undermining and<br />
epithelialization), ten healing patterns were inductively<br />
categorized. We discovered two phenomena: 1) When undermining<br />
was present with no necrotic tissue, the undermining<br />
spread inversely to wound contraction, a phenomenon<br />
we termed as ‘Undermining-spread-partial wound<br />
margin’, (hereafter referred to as ‘Us’). 2) Some epithelialized<br />
wounds closed only by contraction, a phenomenon<br />
we termed as ‘Epithelialization-contraction’, (hereafter referred<br />
to as ‘Ec’).Our results show the wound-healing period<br />
for general epithelialization was longer than for ‘Ec’<br />
type wounds (p = 0.008). The physical factors that influenced<br />
undermining were external bony prominence (p =<br />
0.003), urinary incontinence (p = 0.011), contracture (p =<br />
0.023), and loose skin in the buttock area (p = 0.020). Similarly,<br />
the physical factors that influenced ‘Ec’ were external<br />
bony prominence (p = 0.0016), urinary incontinence (p =<br />
0.001), shear (p = 0.032), and contracture (p = 0.025).<br />
Summary<br />
Based on the healing process for Stage III or IV pressure<br />
ulcers, we discovered the phenomenon referred to as ‘Us’<br />
and ‘Ec’ and inductively categorized ten healing process<br />
patterns. The results show these categories of undermining<br />
and ‘Ec’ to have a significant relationship with external<br />
bony prominence, urinary incontinence and contracture.<br />
The remaining Poster Abstracts from Tampere<br />
will appear in the next issue<br />
Volume 5, Number 3, 2003
epuap News<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
from Italy<br />
DEVELOPMENT OF CONSENSUS UPON THE DESC<strong>RIP</strong>TION OF<br />
PATIENT SUPPORT SURFACES WITHIN ITALY<br />
SUPPORT surfaces; be they beds, mattresses or cushions,<br />
play an important role within pressure ulcer<br />
prevention and management. However, the current<br />
lack of clarity in our definitions of these devices hampers<br />
our ability to compare and contrast different surfaces; for<br />
example when should surfaces be termed dynamic or static;<br />
pressure-relieving, reducing or redistributing? The lack of<br />
common definitions also impacts upon staff training in the<br />
correct use of such aids and prevents national (and international)<br />
agreement upon the role of support surfaces<br />
within pressure ulcer management. At a national level conflicting<br />
and confusing classifications may hamper reimbursement<br />
while posing challenges when developing product<br />
specifications within competitive tenders. These issues<br />
prompted AISLeC to initiate a consensus development<br />
Figure 1. The consensus development group at Livigno, July 2003.<br />
project to improve the description of support surfaces with<br />
the ultimate goal of improving the quality of pressure ulcer<br />
prevention and management in Italy. The fruits of this consensus<br />
upon terminology and support surface evaluation<br />
would be used to assist the national Health Ministry and<br />
regional bodies to update their ‘Prosthesis and Devices Tariff<br />
Nomenclature’ to provide common descriptions of devices<br />
so aiding tender development and staff training in the use<br />
of such interventions.<br />
The consensus process was designed to represent a wide<br />
multi-professional perspective with representatives drawn<br />
from nursing, medicine and biomedical engineering. The<br />
group were tasked to develop a common terminology to<br />
describe support surfaces and to review existing evidence<br />
upon their effectiveness. Beyond the review process a se-<br />
Volume 5, Number 3, 2003 101
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Figure 2. The discussions went on well into the evening …<br />
ries of meetings to review technical issues with members of<br />
the Health Ministry and international experts were also<br />
planned.<br />
The consensus group met in Livigno in the north of<br />
Italy in mid July 2003 with two key objectives; to review existing<br />
national and international guidelines on support surface<br />
use and to discuss, and refine, the aims of the project<br />
with international experts. A series of guidelines were translated<br />
into Italian and addressed within work groups – over<br />
the 40 hours of the consensus meeting the work groups<br />
reviewed translated versions of the <strong>EPUAP</strong> pressure ulcer<br />
guidelines, the US AHCPR guidelines along with pressure<br />
ulcer guidelines and consensus statements from Australia,<br />
Belgium, Canada, France, Singapore, the UK and the USA.<br />
The work of the Cochrane beds and mattresses review group<br />
was also considered by the work groups.<br />
The detailed review conducted by the working groups<br />
was complemented by presentations and comments from a<br />
number of national and international experts including Dan<br />
Bader (UK), Joe Barbenel (UK), Andrea Bellingeri (Italy),<br />
Aldo Calosso (Italy), Michael Clark (UK), Carol Dealey<br />
(UK), Ornella Forma (Italy) and Andrea Nelson (UK).<br />
Following this initial meeting the process will move to<br />
the AISLeC web-site: where a private forum<br />
will allow the consensus development group to work together<br />
upon the development of the final text. Using the<br />
web-site will reduce the need for frequent meetings and so<br />
accelerate the development of the consensus statement. The<br />
goal is to present the consensus statement during a scien-<br />
102<br />
tific meeting with Health Ministry and Court for the Citizens’<br />
Rights representation. This meeting will take place<br />
between 28 April and 1 May 2004 at Lake Garda during the<br />
III° AISLeC Meeting celebrating the first ten years of the<br />
Association. Acceptance of the consensus statement after<br />
the April meeting will begin to ensure common dialogue<br />
between the government, the clinical and scientific communities<br />
and product manufacturers. Such dialogue can<br />
only serve to improve the quality of this important aspect<br />
of pressure ulcer prevention and management. Both the<br />
consensus meeting and the presentation of the consensus<br />
report (28 and 29 April respectively) will be translated into<br />
English.<br />
AISLeC would welcome collaboration with <strong>EPUAP</strong><br />
members who have been involved with similar initiatives to<br />
standardise the definition and evaluation of support surfaces.<br />
Through such collaboration we should seek to achieve<br />
general harmonisation of product descriptions and evaluation<br />
methods across the <strong>European</strong> Community and wider.<br />
If you would like to collaborate please contact us at:<br />
segreteria@aislec.it or abellingeri@venus.it<br />
This document was prepared by the AISLeC Council – Alberto<br />
Apostoli, Alex Bacchilega, Marisa Bergognoni, Andrea<br />
Bellingeri, Sergio Bonelli (past member of the Council), Aldo<br />
Calosso, Pierluigi Deriu, Ornella Forma, Battistino Paggi (past<br />
member of the Council), Cristina Patriarca, Roberto Polignano<br />
with support from Massimo Fornaciari, Raffaele Attolini,<br />
Claudio Solinas.<br />
Volume 5, Number 3, 2003
Volume 5, Number 3, 2003 103
Your abstract should be received by the WUWHS Secretariat (8, rue Tronchet, 75008 PARIS, FRANCE<br />
E-mail: mbia@wanadoo.fr) by 1 February 2004. Authors will be informed of the Scientific Committee’s<br />
decision before 15 April 2004.<br />
104<br />
C A L L F O R A B S T R A C T S<br />
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or downloaded on the web-site: mfgroupe.com, if neither of<br />
these two ways are possible for you, you can send it by post/mail<br />
(on a disk or CD rom) to the Meeting Secretariat at the address<br />
above, or by fax to: +33 1 40 07 10 94.<br />
2. The abstract must be written in Word format (95 or higher).<br />
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abstract. The text to be contained within the area of this blue<br />
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and no abbreviations. Do not centre, start at the left margin.<br />
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9. Structure the abstract following IMReD (Introduction, Methods,<br />
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10.In case of support by a grant, please indicate the source of<br />
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11.Charts or graphs should be inserted in the abstract (files from<br />
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14.Indicate your choice (poster or oral communication, or no<br />
preference).<br />
Volume 5, Number 3, 2003
Executive Trustees<br />
epuap Membership<br />
Dr Denis Colin, President<br />
Centre de l’Arche 72650, Saint Saturnin, France<br />
Tel: +33 243 51 72 57, Fax: +33 243 51 72 67<br />
Denis.Colin2@wanadoo.fr<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
List<br />
Dr Michael Clark, Recorder<br />
Wound Healing Research Unit, Medicentre, University of Wales<br />
College of Medicine, Heath Park, Cardiff, CF4 4XN, Wales.<br />
Tel: 02920 689703, Fax: 02920 754217<br />
Dr George W Cherry, Secretary/Treasurer<br />
Chairman, Wound Healing Institute, Department of Dermatology,<br />
The Churchill Hospital, Headington, Oxford, OX3 7LJ, England.<br />
Tel: 01865 228269, Fax: 01865 228233<br />
Mrs Christine Cherry, Business Administrator<br />
<strong>EPUAP</strong> Business Office, 68 Church Way, Iffley, Oxford, OX4 4EF,<br />
England. Tel: 01865 714358, Fax: 01865 714373<br />
Dr Jeen R E Haalboom, Associate Professor of Internal Medicine,<br />
Dept of Internal Medicine, University Hospital, PO Box 85500, 3508<br />
GA Utrecht, The Netherlands. Tel: 00 31 30 250 6214,<br />
Fax: 00 31 30 253 9060 e-mail: Haalboom@med.ruu.ml<br />
Dr Christina Lindholm, Nattarovagen 42, 13234 Saltsjo-Boo, Sweden<br />
Tel: 00 46 8 715 6263, Fax: 00 46 8 715 4442<br />
Dr Marco Romanelli, Past President<br />
Department of Dermatology, University of Pisa, Via Roma 67,<br />
56126 Pisa, Italy.<br />
Tel: 00 390 50 992 436 or 50 533 387, Fax: 00 390 50 551 124<br />
Mr Joan-Enric Torra i Bou, Consorci Sanitari de Terrassa, Hospital de<br />
Terrassa, Carretera de Terrassa s/n, 08227 Terrassa, Barcelona, Spain<br />
Tel: 00 34 93 731 00 07 (ext 2291), Fax: 00 34 93 731 44 51<br />
Trustees<br />
Mrs Sue Bale, Director of Nursing Research, Wound Healing Research Unit,<br />
University Department of Surgery, UWCM, Heath Park, Cardiff, CF4 4XN,<br />
UK. Tel: 02920 689703, Fax: 02920 745299<br />
Dr Brigitte Barrois, 32 Rue Roger Lemaire, Aulnay/s/Bois 93600 France<br />
Tel: +33 1 3453 2085 Fax: +33 1 3453 2481 bbarrois@ch-gonesse.fr<br />
Mr Mark Collier, 61 Sparrowhawk Way, Hartford, Huntingdon, Cambridgeshire,<br />
PE18 7XE, England. Tel: 020 8280 5020, Fax: 01480 434100<br />
Mrs Carol Dealey, 32 Serpentine Road, Harbourne, Birmingham,<br />
West Midlands, B17 9RE, UK. Tel/fax: 0121 426 5674<br />
Mr Tom Defloor, Nursing Sciences, Univ. of Gent, U.2. Block A 2 o V, De<br />
Pintelaan 185, 9000 Gent, Belgium. Tel/fax: 00 32 50 36 24 38<br />
tom.defloor@urgent.be<br />
Ms Jacqui Fletcher, Principal Lecturer, Univ of Hertfordshire, Hatfield<br />
Campus, College Lane, Hatfield, AL10 9AB, England. Tel: 01707 284000,<br />
Fax: 01707 284954 j.fletcher@herts.ac.uk<br />
Ms Katia Furtado, Rua Viturino Nemesio, No 2 – 7 Esquerdo, 1750–307<br />
Lisbon, Portugal Tel: +351 21 758 8288, Fax: +351 21 313 36434<br />
kfurtado@ip.pt<br />
Professor Finn Gottrup, University Center of Wound Healing, Dept of Plastic<br />
Reconstructive Surgery, Odense University Hospital, Sdr Boulevard 29, DK–<br />
5000 Odense, Denmark. Tel: +45 6542 3903, Mob: +45 4030 3390<br />
Fax: +45 6542 3904 finn.gottrup@ouh.fyns-amt.dk<br />
Dr Laszlo Gulacsi, Bem ter 8, H-4026 Debrecen, Hungary<br />
Tel: +36 52 423 264<br />
Dr Ruud J G Halfens, Vakgroep Verplegingswetenschap, University of<br />
Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.<br />
Tel: 00 31 43 388 2222, Fax: 00 31 43 367 1004<br />
Ms Helvi Hietanen, Head Nurse, HUCH, Toolo Hospital, Dept of Plastic<br />
Surgery, Box 266, 00029 HYKS, Finland<br />
Tel: +358 9 47 17 228, Fax: +358 9 47 17 260<br />
Mr. Maarten Lubbers, Meibergdraas 9, 1100 A2, Amsterdam, The<br />
Netherlands. Tel: 00 31 20 56 69 111, Fax: 00 31 20 69 72 988<br />
Dr Sylvie Meaume, Hopital Charles Foix, 7 Avenue de la Republique, Ivry sur<br />
Seine, 94205, France Tel: 00 33 149 594 504, Fax: 00 33 149 594 524<br />
Zena Moore, The Adelaide & Meath Hospital, Dublin, Eire.<br />
Tel: 003531 414200 (bleep 7190), Fax: 003531 4143576<br />
Prof Elia Ricci, Via P. Crotta 8, 10010 Cascinette d’Ivrea, (TO) Italy<br />
Tel: +39 011 544 747, Fax: +39 011 533 649, eliaricci@tin.it<br />
Anne Witherow, 36 Cappagh Grove, Portstewart, Derry, Northern Ireland.<br />
Tel: 02871 345171 (ext. 3602).<br />
Paying Members<br />
Mr Bill Allan, Smith & Nephew Medical Ltd, PO Box 81, Hessle Road, Hull,<br />
HU3 2BN, England. Tel: 01482 225181, Fax: 01482 328326<br />
Mrs Patrizia Amione, Vulnera C50, Matteotti 35, Turin 10121, Italy.<br />
Tel: +39 011 544 747, Fax: +39 011 533 649 padmion@tin.it<br />
Mrs Irene Anderson, Senior Lecturer, Tissue Viability, Univ of Hertfordshire, Dept<br />
of Nursing & Midwifery, College Lane, Hatfield, Herts, AL10 9AB, England.<br />
Tel: +44 (0)1707 285233 i.1.anderson@herts.ac.uk<br />
Mrs Annelie Andersson, Box 13080, 402 52 Göteborg, Sweden.<br />
Tel: +46 31 722 3105, Fax: +46 31 722 3409, annelie.andersson@molnlycke.net<br />
Mrs Anneke Andriessen, Zwenkgras 25, Malden 6581–RK, The Netherlands.<br />
Tel: +31 24 358 7086, Fax: +31 24 388 0155, anneke.a@ntiscali.nl<br />
Dr Bauk Apotheker, James Stewart Str 125, Almere-Stad, 1325–JC, The Netherlands.<br />
Mrs Leticia Arreytunandia, Lab Knoll SA, Av Burgos 91, Madrid 28050, Spain.<br />
Tel: 00 34 1 334 3900, Fax: 00 34 1 383 1676<br />
Ms Jacqui Ashton, Tissue Viability CNS, Lever Chambers Centre for Health,<br />
Ashburner Street, Bolton, BL1 1SQ<br />
Mrs Shirley Aspin, Whithnell Health Centre, Railway Road, Whithnell, Chorley,<br />
PR6 8UA, England. Tel: 07826 501385, Fax: 01254 832846<br />
Associacao Portuguesa Tratamento de Feridas, Rua Alvares Cabral, 137–Sala 14,<br />
4050–041 Porto, Portugal. Tel: +351 222 026 725, Fax: +351 222 007 890<br />
Ms Stefania Astolfi, Vulnera C50, Matteotti 35, Turin, 10121 Italy.<br />
Tel: 00 39 011 544 747, Fax: 00 39 011 533 649 r.cassino@sicurdata.it<br />
Miss Sally Atkin, Smith & Nephew Medical, PO Box 81, Hessle Road, Hull,<br />
HU3 2BN, England<br />
Prof Elizabeth Ayello, New York University, Division of Nursing, 346 Green Street,<br />
New York, NY 10003, USA Tel: +212 998 5311, Fax: +212 995 4302<br />
elizabeth.ayello@nyu.edu<br />
Ms Carina Baath, Karlstad University, Division for Health and Caring Sciences,<br />
Dept of Nursing, SE–65188 Karlstad, Sweden Tel: +46 54 700 2089<br />
carina.baath@kau.se<br />
Volume 5, Number 3, 2003 105
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Mrs Sue Bale, Dir of Nursing Research, Wound Healing Research Unit, UWCM,<br />
The Medi Centre, Heath Park, Cardiff, CF14 4UJ, Wales<br />
Tel: 02920 682 187, Fax: 02920 754 217<br />
Mr Graham Ball, Jacksons, 8 Mill Field, Barnston, Essex, CM6 1LH, England<br />
Tel: 01371 872 097 graham@roberlimited.com<br />
Ms Katrin Balzer, Zikadenweg 21, 70439 Stuttgart, Germany<br />
Tel: +49 7 11 1882 – 1159 katrin.balzer@kohlhammer.de<br />
Prof Joseph Barbenel, 151 Maxwell Drive, Glasgow, G41 5AE, Scotland<br />
Tel: 0141 427 0705 j.c.barbenel@strath.ac.uk<br />
Dr Brigitte Barrois, 32 Rue Roger Lemaire, Aulnay/s/Bois, 93600 France<br />
Tel: +33 1 3453 2085, Fax: +33 1 3453 2481, bbarrois@ch-gonesse.fr<br />
Mr Neil Bashforth, SSL International plc, Canute Court, Toft Road, Knutsford,<br />
WA16 0NL, England. Tel: +44 (0)1565 625192<br />
neil.bashforth@ssl-international.com<br />
Mrs Joy Bell, 12 Wallace Road, Renfrew, PA4 8AX, Scotland<br />
Tel: +44 (0)141 889 5105 joy.bell@dial.pipex.com<br />
Dr Andrea Bellingeri, Via Flarer 6, Pavia 27100, Italy. Tel: +39 038 422 133,<br />
Fax: +39 038 523 203 ebellingeri@venus.it<br />
Mrs S Benton-Jones, The Nuffield Orthopaedic Centre, Windmill Road,<br />
Headington, Oxford, OX3 7LD, UK.<br />
Mr Joseph Berman, Dept of Physical Therapy, 346 WSC Marqhette University, PO<br />
Box 1881, Milwaukee, Wisconsin, 53201-1881, USA<br />
Tel: 001 414 288 3363, Fax: 001 414 288 5987<br />
Mrs Elaine Bethell, c/o Nursing Admin, City Hospital, Dudley Road, Birmingham,<br />
B18 7QH, UK. Tel: +44 (0)121 554 3801, Fax: +44 (0)121 507 5610<br />
elaine.bethell@swbh.nhs.uk<br />
Mrs Victoria Betteridge, <strong>Pressure</strong> Damage Lead Nurse, Tissue Viability Service,<br />
Abingdon Hospital, Marcham Rd, Abingdon, OX14 1AG, England<br />
Tel: 01235 205789, Fax: 01235 205788<br />
Mr Bert Billen, The ROHO Group, Peter Valentinuslaan 4, B–3500 Hasselt,<br />
Belgium Tel: 00 31 1128 4359, Fax: 00 31 1128 1517, bbillen@attglobal.net<br />
Mr Itzak Binderman, School of Dental Medicine, Tel-Aviv University, Ramat Aviv,<br />
69978 Tel Aviv, Israel Tel: +972 3 695 1835, Fax: +972 3 640 9250<br />
binderma@post.tau.ac.il<br />
Miss Rachael Blewett, 27 Eskmont Ridge, Upper Norwood, London, SE19 3PZ,<br />
England Tel: 020 8700 0232 Fax: 020 8653 3597 rachael_blewett@hotmail.com<br />
Dr Mary Bliss, Oaklea, Badgers Mount, Sevenoaks, Kent, TN14 7AY, England<br />
Tel: +44 (0)1959 534278<br />
Helen Boon, Wallsend Health Centre, The Green, Wallsend, Tyne and Wear,<br />
NE28 7PD, England Tel: 0191 220 5991, 0191 220 5943<br />
helen.boon@northumbria-healthcare.nhs.uk<br />
Mrs Th CM Bots, Silversteyn 64, 3621 PD Breukelen, The Netherlands.<br />
Tel: +31 346 264 208, Fax: +31 346 264 163 postbus@thbots.demon.nl<br />
Dr Gerrie Bours, Maastricht Univ, Dept Nursing Science, PO Box 616, Maastricht<br />
6200 MD, The Netherlands. Tel: +31 43 388 1279, Fax: +31 43 388 4162<br />
G.Bours@zw.unimaas.nl<br />
Dr Carlijn Bouten, Eindhoven University of Technology, Department of Biomedical<br />
Engineering, PO Box 513, 5600 MB, Eindhoven, The Netherlands.<br />
Tel: 00 31 40 247 3006, Fax: 00 31 40 244 7355 c.v.c.Bouten@tue.nl<br />
Mr C.H. Bronner, PO Box 616, 6200 MD, Maastricht, The Netherlands.<br />
Tel: +33 43 388 1544, Fax: +33 43 388 4162 c.bronner@zw.unimaal,nl<br />
Miss Jill Brooks, Abingdon Hospital, Marcham Road, Abindon, Oxford,<br />
OX14 1AG, England. Tel: 01993 774126, Fax: 01992 706947<br />
jill.brooks@oxch-tr.anglox.nhs.uk<br />
Mrs Helen Brough, NHS Purchasing & Supply Agency, 80 Linghtfoot Street,<br />
Chester, CH2 3AD, England Tel: +44 (0)1244 586809, Fax: +44 (0)1244 586828<br />
helen.brough@pasa.nhs.uk<br />
Mr Edwin Buttfield, Talley Group Ltd, Premier Way, Abbey Park Industrial Estate,<br />
Romsey, Hants, SO51 9AQ, England. Tel: 01794 503557, Fax: 01794 503555<br />
Miss Rosemarie Callaghan, Evesham Community Hospital, Waterside, Evesham,<br />
WR11 6JT, England callaghankids1@hotmail.com<br />
Dr Gianna Rita Carella, ‘C Golgi’ Geriatric Institute, Piazza Golgi 11, Abbiate-grasso<br />
(Milan) 20081, Italy. Tel: +39 029 466 771 Fax: +39 029 496 808<br />
106<br />
Ms Lucy Carroll, 30 Larkfield Grove, Harolds Cross, Dublin 6W, Ireland.<br />
Tel: +353 1 492 3194 lkcarroll@eircom.net<br />
Dr Roberto Cassino, Vulnera-Corso, Matteotti 35, Torino 10121, Italy.<br />
Tel: +39 011 544 747, Fax: +39 011 533 649 r.cassino@sicurdata.it<br />
Ms Andrea Cavicchioli, Via Siligardi 14, 41100 Modena, Italy Tel: +39 059 440124,<br />
Fax: +39 059 399210 cavicchioliandrea@hotmail.com<br />
Mrs Tina Chambers, 5 Wren Close, Ringwood, Hants BN24 3RF, England.<br />
Tel: 01425 471291, Fax: 01962 824826 tina.chambers@weht.swest.nhs.uk<br />
Miss Chryso Charalambous, Makarious III 24, Tseri, Nicosia, Cyprus<br />
Tel: +357 99 584 248<br />
Dr Michael Clark, Wound Healing Research Unit, UWCM, The Medi Centre,<br />
Heath Park, Cardiff, CF14 4UJ, Wales. Tel: 02920 682 191, Fax: 02920 754 217<br />
Ms Nicky Clark, Tissue Viability Nurse, Queen Elizabeth Hospital, Metchley Park<br />
Road, Edgbaston, Birmingham, B15 2TQ, England<br />
Mrs Ann Cobb, Harrogate District Hospital, Lancaster Park, Harrogate, North<br />
Yorks, GH2 7SX, England. Tel: 01423 881604, Fax: 01423 553624<br />
ann@cobb51-fsnet.co.uk<br />
Dr Denis Colin, Medical Director, Centre de l’Arche, 72650 Saint Saturnin,<br />
Le Mans, France. Tel: +33 243 51 72 67, Fax: +33 243 51 72 57<br />
denis.colin@antivirus.oleane.com<br />
Mr Mark Collier, The Old Dairy, Byards Leap Farm, Cranwell, Sleaford, Lincs,<br />
NG43 8EY, England. Tel: 07785 297663 mark.collier@ulh.nhs.uk<br />
Mrs Fiona Collins, TVCS Limited, Master Building, Compton Place Road,<br />
Eastbourne, East Sussex, BN20 8HP, England. Tel: +44 (0)1323 735588,<br />
Fax: +44 (0)1323 737132 fiona.collins1@btinternet.com<br />
Ms Catherine Considine, 2 The Drive, Melrose Park, Swords, Co. Dublin, Ireland<br />
Tel: +353 1 886 0953 / 840 7792, Fax: +353 1 836 3813<br />
Mrs Joanne Conway, The Royal Oldham Hospital, Room 14, Chalmers Keddre<br />
Building, Rochdale Road, Oldham, OL1 2JM, England Tel: +44 (0)161 627 8423,<br />
Fax: +44 (0)161 627 8554 joanne.conway@oldham-tr.nwest.nhs.uk<br />
Miss Pamela Cooper, Clinical Nurse Specialist, Dept of Tissue Viability, Foresthill,<br />
Grampion University Hospital, AB25 2ZN, Scotland.<br />
Tel: 01224 554621, Fax: 01224 849139<br />
Miss Fiona Coull, c/o Nursing Directorate, Royal Free Hospital, Pond Street,<br />
London, NW3 2QG, England Tel: 020 7472 6439, Fax: 020 7830 2961<br />
fiona.coull@rfh,nthanes.nhs.uk<br />
Ms Gerardine Craig, Broadmeadow, Drumshallow, Grangebellen, Drogheda, Co.<br />
Leith, Ireland Tel: +353 41 988 1515<br />
Mrs Barbara Craven, Disability Services, Walton Hospital, Whitecotes Lane,<br />
Chesterfield, Derbyshire, S40 3HW, England. Tel: +44 (0)1246 552917 (ext 5707)<br />
Fax: +44 (0)1246 557958 barbara.craven@nederbypct.nhs.uk<br />
Ms Jean Cregg, 9 Goddards Lane, Aldbourne, Marlborough, Wilts, SN8 2DZ,<br />
England. Tel: 01282 432072, Fax: 01282 421597<br />
Ms Mary Curran, Nursing Practice Development Unit, St James’s Hospital, James’s<br />
Street, Dublin 8, Ireland Tel: +353 1416 2454, Fax: +353 1410 3412<br />
mmcurran@stjames.ie<br />
Ms Ann Daenekindt, Stapelplein 70, Gent 9000, Belgium. Tel: +32 9 265 8770,<br />
Fax: +32 9 265 8771 ann.daenekindt@huntleigh-healthcare.be<br />
Dr Sarah Daniels, Harrington House, Milton Road, Ickenham, Uxbridge,<br />
Middlesex, UB10 8PU, England. Tel: 01895 628395, Fax: 01895 628338<br />
Prof Theo Dassen, Albrechtstrasse 15, 10117 Berlin–Mitte, Germany<br />
Tel: +49 30 450 529 092, Fax: +49 30 450 529 900 theo.dassen@charitl.de<br />
Mrs Claire Davies, Middlesex University, Archway Campus, Furnival Building,<br />
Nightgate Hill, London, N19 5LW, England.<br />
Tel: +44 (0)20 8411 6708 c.davies@mdx.ac.uk<br />
Mrs Patricia Davies, School of Primary Health Care, University of Central England,<br />
Westbourne Road, Birmingham, B15 3TN, England.<br />
Tel: +44 (0)121 331 7104 patricia.davies@uce.ac.uk<br />
Mrs Carol Dealey, Research Dev. Team, University Hospital Birmingham NHS<br />
Trust, 4th Floor, Nuffield House, QEMC, Birminham, B15 2TH, England.<br />
Tel: (and Fax:) 0121 426 5674 carol.dealey@uhb.nhs.uk<br />
Dr Tom Defloor, Kerklaan 58, Brugge 8310, Belgium<br />
Tel: 00 32 50 36 24 38, Fax: 00 32 50 36 24 38 tom.defloor@urgent.be<br />
Volume 5, Number 3, 2003
Dr Maaike De Jager, Postbus 1, 2700 MA Zoetormeer, The Netherlands.<br />
Tel: +31 79 353 9673, Fax: +31 79 353 9730 Maaike.dejager@nutricia.nl<br />
Mr Germain de Keyser, Kapucijnenvoer 35, 3000 Leuven, Belgium<br />
Tel: 00 32 1633 2211, 00 32 1922 8349 germain.dekeyser@pandora.be<br />
Dr Erik de Laat, University Medical Centre Nijmegen, 111 Staf Zorg, PO Box 9101,<br />
6500 HB Nijmegen, The Netherlands Tel: +31 24 361 6560,<br />
Fax: +31 24 354 1456 e.delaat@zorg.azn.nl<br />
Mr Fredrik Delas, Bryggenveien 42, 1747 Skjeberg, Norway<br />
Tel: +47 930 22 712, Fax: +47 69 33 6606 fd@alurehab.com<br />
Mr Dirk De Wolf, Prinsenmeers 9, Dendermonde, B–9200 Belgium.<br />
Tel: +31 52 21 5872 dirk.de.wolf@pi.be<br />
Miss Meike Dewin, Academisch Ziekenhuis, Directir Vorpleging, Laarbeecklaan<br />
101, 1090 Brussels, Belgium. Tel: +31 2 477 5577, Fax: +31 2 477 5593<br />
dirndwnm@azwb.ac.be<br />
Mr Peter Diesing, Buchbinder Weg 55, 12355 Berlin, Germany<br />
Tel: +49 30 664 61709, Fax: +49 30 664 61708 peter.diesing@gmx.de<br />
Mrs Jeannie Donnelly, 6 Mount Royal, Bangor, Co. Down, BT12 6BA, Northern<br />
Ireland Tel: +44 (0)28 914 68875 jeannie.donnelly@royalhospitals.n-i.nhs.uk<br />
Ms Valerie Dowley, Practice Development Specialist, Pegasus Limited, Waterberry<br />
Drive, Waterlooville, Hants, PO7 7XX, England<br />
Dr Inge Duimel-Peeters, Wirixstraat 22, Tongeren, 3700 Belgium<br />
Tel: +31 43 388 1557, Fax: +31 43 388 4162 i.duimel@xw.unimaas.nl<br />
Dr Sonia Dumit-Minkel, 1231 E. Donges Crt, Bayside, Wisconsin 53217, USA<br />
Tel: (and Fax:) 001 414 228 0101 duminkel@yahoo.com<br />
Mrs Cheryl Dunford, School of Nursing and Midwifery, Nightingale Building,<br />
University Road, Highfield, Southampton, SO17 1BJ, England<br />
Mrs Jane Edwards, 17 Windrush Way, Abingdon, Oxon, OX14 3SX, England.<br />
Tel: 01865 227312 (work) Fax: 01865 742348 jane.l.edwards@noc.anglox.nhs.uk<br />
Mrs Lynfa Edwards, 135 Kenyngton Drive, Sunbury, Middlesex, TW16 7RU,<br />
England. Tel: 01932 789022<br />
Ms Jacqui Elst, Weide 93, 5103 HT Dongen, The Netherlands<br />
jacam.elst@wanadoo.nl<br />
Mrs Wendy Eve, Saiyang, 30 Torton Hill Rd, Arundel, West Sussex, BN18 9HL,<br />
England Tel: 01243 623661, Fax: 01243 623664 wendyeve@u.genie.co.uk<br />
Mrs Leone Ewings, Tissue Viability CNS, Nurse Practice Development Unit,<br />
Beaumont Hospital, Beaumont, Dublin 9, Ireland. Tel: +353 1 809 2533<br />
leone.ewings@beaumont.ie<br />
Ms Caterina Falce, 109 Barnet Road, Potters Bar, Herts, EN6 2RN, England<br />
Tel: +44 (0)1707 859153, Fax: +44 (0)1707 664889 caterinafalce@yahoo.co.uk<br />
Carlos Ferrer, Smith & Nephew SA, Fructuos Gelabert 2 y 4, 08970 Sant Juan<br />
Despi, Barcelona, Spain Tel: +34 93 373 7301, Fax: +34 93 373 7453<br />
Ms Johanna Feuchtinger, St-Agatha-Weg 5, 79108 Freiburg, Germany<br />
Tel: +49 7665 938093 Fax: +49 7612 706153 johanna.feuchtinger@gmx.de<br />
Dr Rosy Fittipaldi, Via Ticinello No. 34, Pavia, 27100 Italy<br />
Tel: +39 333 9452041 rosi.fittipaldi@libero.it<br />
Ms Cynthia Fleck, The ROHO Group, 100 North Florida Avenue, Belleville,<br />
Illinois, 62221, USA Tel: +618 277 9173, Fax: +618 277 9561<br />
cynthiaf@therohogroup.com<br />
Mrs Jacqui Fletcher, University of Hertfordshire, Hatfield Campus, College Lane,<br />
Hatfield, Herts, AL10 9AB, England Tel: +44 (0)1707 285266,<br />
(home: 01462 850495), Fax: +44 (0)1707 284954 j.fletcher@herts.ac.uk<br />
Mr Håkan Freijd, MedTec Nordic AB, Vinbarsvagen 14, S–734 31 Hallstahammar,<br />
Sweden. Tel: +46 220 126 23, Fax: +46 220 126 23 medtecnordic@netscape.net<br />
Mr John Furness, Vital Base AS, Myravegen 2, Hareid, NO–6060, Norway<br />
Tel: +47 700 95959, Fax: +47 700 95951 john@vitalbase.no<br />
Ms Katia Furtado, Rua Viturino Nemesio, No.2–7 Esquerdo, 1750-307 Lisbon,<br />
Portugal. Tel: +351 21 758 8288, Fax: +351 21 313 36434 Kaxfurtado@clix.pt<br />
Mr Lucas Garabet, GerroMed GmbH, Fangdieckstra 75B, Hamburg 22547,<br />
Germany. Tel: +49 40 547 3030, Fax: +49 40 547 30331 GarabetL@Gerromed.de<br />
Ms Tracy Gardner, Professional Development Specialist, Pegasus Limited,<br />
Waterberry Drive, Waterlooville, Hants, PO7 7XX, England Tel: 02392 784200<br />
<strong>EPUAP</strong> MEMBERS<br />
Prof Stefano Gasperini, Via V Maroso, 50, c/o Bristol Myers Squibb, Div. ConvaTec,<br />
Roma 00142, Italy. Tel: +39 6 50 396378 stefano.gasperini@bms.com<br />
Mrs Pauline Gatto. 28 Spencer Avenue, Palmers Green, London, N13 4TR,<br />
England Tel: +44 (0)20 8340 5215 pauline.gatto@haringey.nhs.uk<br />
Kjetil Gausel, Dreierhagen 21, Sandnes, 4321 Norway<br />
Tel: +47 9 805 1111, Fax: +47 5 158 1889, kg@alurehab.com<br />
Mr Krzysztof Gebhardt, PUPT, Room 0.195, Ground Floor, Lanesborough Wing,<br />
St George’s Hospital, Blackshaw Road, London, SW5 0AH, England.<br />
Tel: +44 (0)20 8725 2230, Fax: +44 (0)20 8725 1071<br />
chris.gebhardt@stgeorges.nhs.uk<br />
Mrs Elaine Gibson, 21 St Mary’s Green, Kennington, Ashford, Kent, TN24 9HP,<br />
England. Tel: 01233 626837 gibse@btinternet.com<br />
Ms Marguerite Gordon, 7 Hampstead Park, The Rise, Glasnevin, Dublin 9, Ireland.<br />
Tel: +353 1 836 0875, Fax: +353 1 848 7821<br />
Dr Davina Goswell, 1733 Elm Drive, Kent, 44240 Ohio, USA<br />
Tel: 001 330 672 3777, Fax: 001 330 672 2433 dgoswell@kent.edu<br />
Dr Allison Graham, 75 Mellstock Road, Aylesbury, Bucks, HP21 7NX, England<br />
Tel: 01296 315851, Fax: 01296 315867<br />
Dr Jeffrey Graham, Dept of Health, Room LG24, Wellington House, Walterloo<br />
Road, London, SE1 8UG, England Tel: 020 7972 4710, Fax: 020 7972 4405<br />
Mr Mark Green, 1 Greenwood Avenue, Horwich, BL6 6FA, UK.<br />
Dr Laszlo Gulacsi, Bem ter 8, H–4026 Debrecent, Hungary.<br />
Mrs Lena Gunningberg, Department of Nursing Research and Development,<br />
University Hospital, 75185 Uppsala, Sweden. Tel: +46 18 611 3194,<br />
Fax: +46 18 611 3025 lena.gunningberg@adm.uas.lul.se<br />
Dr Jeen RE Haalboom, Dept. of Internal Medicine, University Hospital,<br />
Heidelberglaan 100, Utrecht 3508, The Netherlands.<br />
Tel: 00 31 30 250 6214, Fax: 00 31 30 253 9060<br />
Dr Satsue Hagisawa, Nagoya City University, School of Nursing, Kawasumi 1,<br />
Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. Tel: +81 52 853 8074<br />
Dr Ruud Halfens, Praaglaan 123, 6229 HR Maastricht, The Netherlands.<br />
Ms Tracey Hamlyn, 61 Lydford Park Road, Peverell, Plymouth, PL3 4LQ, England<br />
Tel: 01752 670601<br />
Mr Mark Hammonds, Coronary Care Unit, James Cook University Hospital,<br />
Marton Road, Middlesborough, TS4 3BW, England<br />
Tel: 01642 854801, Tel: 01642 854196<br />
Miss Jane Hampton, 25 Trentham St, Southfields, London, SW18 5AS England.<br />
Tel: 020 8846 6544, Fax: 020 8846 6543<br />
Dr Carita Hansson, Dept of Dermatology, Wound Healing Centre, Sahlgrenska<br />
University Hospital, 41345 Göteborg, Sweden<br />
Tel: +46 31 342 1000, Fax: +46 31 821 1871<br />
Mrs Lucy Harper, 50 Somersall Street, Mansfield, Notts., NG19 6EP, England.<br />
Tel: 01623 456063 lucy@ntlworld,com<br />
Ms Jussi Heikkila, Kuoppatie 4, PO Box 25, Helsinki, 00731 Finland<br />
Tel: +358 9 346 2574, Fax: +358 9 346 2576 jussi.heikila@icfgroup.fi<br />
Dr Eva-Lisa Heinrichs, ConvaTec Ltd, Harrington House, Milton Rd, Ickenham,<br />
Uxbridge, Middlesex, UB10 8PU, England.<br />
Tel: 01895 628330, Fax: 01895 628332 eva-lisa.heinrichs@bms.com<br />
Ms Taina Hemmila, Kuoppatie 4, PO Box 25, Helsinki, 00731 Finland<br />
Tel: +358 9 346 2574, Fax: +358 9 346 2576 taina.hemmila@icfgroup.fi<br />
Ms Val Henderson, Tissue Viability Nurse, Joint Equipment Loan Store, 43<br />
Colbourne Crescent, Nelson Industrial Estate, Cramlingham, Northumberland,<br />
England<br />
Mr Jan Hermkens, Weymar Straat 8, Maasbree, 5993 CT, The Netherlands.<br />
Tel: +31 77 465 2676, Fax: +31 77 465 1599 jan.hermkens@wxs.nl<br />
Ms Hilde Heyman, Karel VD, Woestynelaan 40, 2630 Aartselaar, Belgium<br />
Tel: +31 3 289 4087<br />
Ms Helvi Hietanen, Tonttumuorinkija 1, 02200 Espoo, Finland.<br />
Tel: +35 85 001 02947, Fax: +35 89 412 5074 hetu.hietanen@magabaud.fi<br />
Ms Raija Hietikko, Karhusyuontie 14, Fin–02810 Espoo, Finland.<br />
Tel: +358 50 344 7127, raija.hietikko@hus.fi<br />
Volume 5, Number 3, 2003 107
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Mrs Monica Hofmann-Rosener, HNE Healthcare, Im Hulsenfeld 19, 40721<br />
Hilden, Germany. Tel: +49 2013 97110 Fax: +49 2013 971146<br />
hne.hofrose@t-online.de<br />
Ms Alison Hopkins, 8 Plas Taliesin, Penarth Marina, Penarth, CF64 1TN, Wales,<br />
UK hopkins72@yahoo.com<br />
Dr Ronald Houwing, Department of Dermatology, Deventer Ziekenhuis, Postbus<br />
5001, 7400-GC Deventer, The Netherlands Tel: +31 570 646666<br />
Fax: +31 570 677919 houwing@dz.nl<br />
Ms Ansa Iivanainen, Potnolankatu 5, Mikkeli, 50120 Finland.<br />
Tel: +358 15 150 632, Fax: +358 15 355 6686 ansa.iivanainen@mikkeliamk.fi<br />
Mrs Sue Jackson, 180 Ecclesshall Road, Stafford, Staffs ST16 1JA, England<br />
Tel: +44 (0)1785 253000<br />
Ms Julie Jordan-O’Brien, Tissue Viability CNS, Nurse Practice Development Unit,<br />
Beaumont Hospital, Beaumont, Dublin 9, Ireland.<br />
Tel: +353 1 809 2533 julie.jordanobrien@beaumont.ie<br />
Dr Wilhelm Jung, Global Category Manager–Debridement, Smith & Nephew<br />
Medical Ltd, PO Box 81, Hessle Rd, Hull, HU3 2BN, England.<br />
Tel: 01482 673030, Fax: 01482 673307, willi.jung@smith-nephew.com<br />
Dr Vesa Juutilainen, Pitkankalliontie 14 B 11, Espoo, 02170 Finland<br />
vesa.juutilainen@kolumbus.fi<br />
T. Kaldijk, Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ, Maastricht,<br />
The Netherlands. Tel: +31 43 387 5912, Fax: +31 43 387 5142<br />
tka@frev.azm.nl<br />
Mr Raija Kanniainen, Perkionkuja 5B, 01670 Vantaa 67, Finland.<br />
Tel: +358 9 270 92793, Fax: +358 9 270 92798 raijakanniainen@hotmail.com<br />
Dr Paul Keller, University Medical Centre, Utrecht, 3508 GA, The Netherlands<br />
Tel: +31 30 250 8075<br />
Ms Helena Kelly, Keaney Medical Ltd, Clinitron House, 6 Greenhills Business Park,<br />
Talloght, Dublin 24, Ireland. Tel: +353 1 459 6585, Fax: +353 1 459 6634<br />
Mrs Bernadette Kerry, Lahinch, Durrow, Tullamore, Co. Offaly, Ireland<br />
Tel: +353 506 28075, Fax: +353 506 31175 bernie.kerry@mhb.ie<br />
Dr Morris Kerstein, 1214 Valley Road, Villanova, PA 19085–2124, USA<br />
Tel: 001 610 527 4316, Fax: 001 610 520 9293 LK1122@prodigy.net<br />
Mrs Joyce Khoulowa, c/o Ward 23, York District Hospital, Wiggington Road, York,<br />
YO31 8HE, England. Tel: 01904 725966<br />
Mrs Brenda King, 12 Beckton Ave, Waterthorpe, Sheffield, S20 7NA, England.<br />
Tel: 0114 271 6416, Fax: 0114 271 6417, brenda.king@virgin.net<br />
Prof Luther Kloth, Dept of Physical Therapy, Marquette University, PO Box 1881,<br />
Milwaukee, WI 53201-1881 USA. Tel: 001 414 288 3381, Fax: 001 414 288 5987<br />
Mr E. Koopman, Deventer Ziekenh Stg, Fesevurstraat 7, 7415 CM Deventer, The<br />
Netherlands. Tel: +31 (0)570 646 078 koopman@dz.nl<br />
Me Eva Krahenbuhl, Ardo Medical AG, Gewerbestrasse 19, 6314 Unterageri,<br />
Switzerland. Tel: +41 417 57 70 70, Fax: +41 417 57 70 71<br />
eva.krahenbuhl@ardo.ch<br />
Mr Samuel Krahenbuhl, ARDO Medical AG, Gewerbestrasse 19, 6314 Unterageri,<br />
Switzerland. Tel: +41 417 54 70 70, Fax: +41 417 54 70 71<br />
samuel.krahenbuhl@ardo.ch<br />
Mr Nils Lahmann, Ziegelstr 5, D–10117 Berlin, Germany<br />
Tel: +49 30 450 529066, Fax: +49 30 450 529900 nils.lahmann@charite.de<br />
Ms Catriona Lally, Clinical Specialist, Kaymed, Bluebell Industrial Estate, Naas<br />
Road, Dublin 12, Ireland Tel: +353 1 419 2938, Fax: +353 1 460 2574<br />
lallyc@kayfoam.com<br />
Mr Larry Lankard, 8550 Balboa Boulevard, No. 214, Northridge, CA 91325, USA<br />
Tel: 001 818 894 0744, Fax: 001 818 894 7972 larry.lankard@bgind.com<br />
Mr Bernier Laurent, Asymptote, Le Green – Rue des Granges, Dommartin, 69380<br />
France. Tel: +33 478 435 127, Fax: +33 478 435 172<br />
Miss Sylvia Leonard, 7 Brackendale Grove, Luton, Beds, LU3 2LT, England<br />
Tel: +44 (0)1582 495036 lem65@tiscali.co.uk<br />
Ms Sarah Lewis, 14 Lancaster Road, Walthamstow, London, E17 6AJ, England.<br />
Tel: 020 8503 3921 sarah.lewis@uclh.org<br />
Ms Doris Liddy, Tissue Viability Nurse, UCHG, Newcastle Road, Galway City,<br />
Ireland. Tel: +353 (0)91 542115, doris.liddy@hsi.ie<br />
108<br />
Mrs Pirjo Lietzen, Jonsaksenpolku 1 A 22, Fin–01600 Vantaa, Finland<br />
Tel: +358 50 372 0280, Fax: +358 9 310 50330 pirjo.lietzen@luukku.com<br />
Dr Christina Lindholm, Director Clinical Research, Karolinska Hospital, S–171 76<br />
Stockholm, Sweden. Tel: +46 8 517 798 82, Fax: +46 8 517 799 68<br />
christina.lindholm@ks.se<br />
Mr Armin Littek, Box 14435, Kilkirnie, Wellington, New Zealand<br />
Tel: +64 4 383 5790, Fax: +64 4 383 5797 armin@med-dev.co.nz<br />
Mrs Menna Lloyd-Jones, Beechwood House, Bridge Street, Dolgellau, LL40 1AU,<br />
Gwynedd, Wales, UK Tel: +44 (0)1341 421412, Fax: +44 (0)1341 422059,<br />
menna.jones@nww-tr.wales.nhs.uk<br />
Ms Pille Loit, Tammsaane 61–9, 13715 Tallinn, Estonia<br />
Tel: +372 51 84008, Fax: +372 67 11509<br />
Mr Reinier J. Lorist, Oude Waal t.o.10, 1011 CG, Amsterdam, The<br />
Netherlands Tel: +31 20 62 02962, Fax: +31 20 599 2299 r.j.lorist@olvg.nl<br />
Dr Maarten Lubbers, Surgeon AMC, Meibergdreef 9 1105 AZ, Amsterdam, The<br />
Netherlands. Tel: 00 31 20 566 9111, Fax: 00 31 20 697 2988<br />
Ms Elja Luotola, Hakalantanhua 15, Fin–29100 Luvia, Finland<br />
Tel: +358 2 558 3300, eija.luotola@jippii.ji<br />
Ms Yvonne Lutgens, Nieuwe Uilenburgerstraat 10B, 10011 LP Amsterdam, The<br />
Netherlands. Tel: +31 20 566 9111 Fax: +31 20 566 9568<br />
y.h.lutgens@amc.uva.nl<br />
Ms Gwendolyn Macintyre, 153 Kilpatrick Gardens, Clarkston, Glasgow, G76 7RN,<br />
Scotland, UK Tel: +44 (0)141 638 0360 billmacintyre@yahoo.co.uk<br />
Ms Lybda Mapplebeck, Tissue Viability Specialist, Kingsley Grove Clinic, Grimsby,<br />
Lincs, DN33 1NL, England<br />
Mr George Maroutsis, 24 Filellinon Street, Halandri, GR–152, 32 Athens, Greece<br />
Tel: +30 168 12 522, Fax: +30 168 16 706 gmaroutsis@msjacovides.com<br />
Mr Andrew Cox Martin, Dept of Medical Engineering, Salisbury District Hospital,<br />
Salisbury, Wilts, SP2 8BJ, England. Tel: 01722 425138 Fax: 01722 416227<br />
bill@medengsdh.demon.co.uk<br />
Mrs Laura Martin, 6 Parkgate Road, Temple Patrick, Ballyclare, BT39 0DF,<br />
Northern Ireland. Tel: 028 9443 2667 laura@martinparkgate.freeserve.co.uk<br />
Mrs Ruth Martin, Wound Care Team, Wandsworth PCT, St John’s Therapy Centre,<br />
162 St John’s Hill, Battersea, London, SW11 1SP. Tel: +44 (0) 208 700 0232<br />
Fax: +44 (0) 208 700 0203 ruth.martin@swlondon.nhs.uk<br />
Dr Marco Masina, Via Andrea Costa 5, S Giorgio Di Piano (BO), 40016 Italy<br />
Tel: +39 339 305 1053, Fax: +39 051 66 44491 marc_mas@yahoo.com<br />
Mr John Masso, 412 Hancock Place, Fairview, New Jersey, 07022–1810, USA<br />
Tel: 001 201 941 8493, Fax: 001 201 943 1726 chichimambo@ix.netcom.com<br />
Mr Anton Mayrhauser, Ketzergasse 39 (FA Sunmed), 1232 Vienna, Austria<br />
Tel: +43 1699 2299 Fax: +43 1699 2299-1 mayrhauser@ sunmed.at<br />
Dr Alistair McLeod, Huntleigh Technology PLC, 310-312 Dallow Road, Luton,<br />
LU1 1TD, England. Tel: 01582 745768, Fax: 01582 745862<br />
Ms Mary McMahon, St Joseph’s Ward, Cappagh National Orthopaedic Hospital,<br />
Finglas, Dublin 11, Ireland.<br />
Ms Geraldine McNulty, 8 Avondale Court, Manor West, Tralee, Co. Kerry, Ireland.<br />
Tel: +353 66 712 1314, Fax: +353 66 712 4515 grmcn@eircom.net<br />
Mr Kevin Mearns, Talley Group Limited, Premier Way, Abbey Park Industrial<br />
Estate, Romsey, Hants, SO51 9AQ, England. Tel: 01794 503557,<br />
Fax: 01794 503555 kmearns@talleymedical.co.uk<br />
Dr Sylvie Meaume, Hopital Charles Foix, 7 Avenue de la Republique, Ivry sur<br />
Seine, 94205, France Tel: 00 33 149 594 504, Fax: 00 33 149 594 524<br />
sylvie.meaume@cfx.ap-hop-paris.fr<br />
Dr Elke Mertens, Wielandstr 24, 12159 Berlin, Germany<br />
Tel: +49 30 859 1136, Fax: +49 30 450 529 900 elke.mertens@charite.de<br />
Mrs Janine Michaelides, The Cyprus Ass. of Cancer Patients and Friends, 6 Pindou<br />
Street, Limassol 3035, Cyprus. Tel: +357 574 7750, Fax: +357 574 7668<br />
janinemichaelides@yahoo.com<br />
Mrs Christina Miguens, R Rangel de Lima, No. 12, 3320–229 Pampilhosa Da Serra,<br />
Portugal miguens.gouveia@clix.pt<br />
Mrs Zena Moore, Kuldana, 11 Beech Park Avenue, Castleknock, Dublin 1, Ireland.<br />
Tel: +353 1 821 6775, Fax: +353 1 414 3576 zena.moore@amnch.ie<br />
Volume 5, Number 3, 2003
Ms Margaret Moriaty, Tissue Viability Specialist, Dartford, Gravesend and Swanley<br />
PCT, Gravesend Hospital, Ward M4, Bath Street, Gravesend, Kent, DA1 0DG,<br />
England. Tel: 01474 564333<br />
Mr Will Morris, Pinfold House, Pinfold Lane, Alltami Mold, Flintshire, CH7 6NZ,<br />
England. Tel: 01244 541800, Fax: 01244 547555<br />
willmorris@nightingalebeds.co.uk<br />
Mrs Deborah Murphy, 28 Tintagel Close, Feniscowles, Blackburn, Lancs, BB2 5JN.<br />
England Tel: +44 (0)1254 201253 debmurphy123@hotmail.com<br />
Mr Olavi Murros, Kuoppatie 4, PO Box 25, 00731 Helsinki, Finland.<br />
Tel: +358 9 346 2574, Fax: +358 9 346 2576 olavi.murros@icfgroup.fi<br />
Mrs Anne Myer, 22951 Femes, Mission Viejo, California, 92692–1424, USA<br />
Tel: +1 949 770 9316 Fax: +1 949 767 5998 woundcare@cox.net<br />
Mrs Marilyn-Agnes Ngoh, 11 Maxwell Court, Dulwich Common, London, SE22<br />
8NT, England Tel (+Fax): +44 (0)20 8299 6690 mangoh2001@aol.com<br />
Mrs Jane Nixon, Centre for Evidence Based Health Care, University of Huddersfield,<br />
Harold Wilson Building, Queensgate, Huddersfield, HD1 3DH, England.<br />
Tel: 01484 473645 j.nixon@hud.ac.uk<br />
Ms Birgit Nordlund, Salamapujankatu 18, F 41, Fin–65370 Vaasa, Finland<br />
Tel: +358 6 316 9617 birgit.nordlund@vshp.fi<br />
Mrs Pirjo Nurminen, Simpukkakie 14, Fin–48310 Kotka, Finland<br />
Tel: +358 5 2604 181 (or +358 40 7409 709) pirjo.nurminen@kymshp.fi<br />
Mrs Pia Obank, Lane End Surgery, Finings Road, Lane End, Bucks, HP14 3ES,<br />
England Tel: 01494 883364<br />
Miss Louise O’Connor, 37 Clough House Drive, Leigh, Lancashire, WN7 2GD,<br />
England. Tel: 0161 291 3227 louise.oconnor@smunt.nwest.nhs.uk<br />
Mrs Linda O’Flynn, Holly Lodge, 57 London Road, Datchet, Berks, SL3 9JY,<br />
England Tel: 01753 545640, Fax: 01753 860441<br />
linda-oflynn@btinternet.com<br />
Dr Takehiko Ohura, Kojinkai <strong>Pressure</strong> <strong>Ulcer</strong> Wound Healing Res. Center,<br />
7F, H&B Plaza Bld 1-1, West 2, South 3, Chuo-ku, Sapporo, 060–0063 Japan<br />
Tel: +81 11 232 2208, Fax: +81 11 232 5181 t.ohura@mb.snowman.ne.jp<br />
Dr Cees Oomens, Eindhoven Univ of Technology, Mech Eng Dept, PO Box 513,<br />
5600 MB, Eindhoven, The Netherlands. Tel: +31 40 247 2818,<br />
Fax: +31 40 244 7355 oomens@wfw.wtb.tue.nl<br />
Dr Forma Ormella, Via Carlo Porte 3, Voltorre di Gavirate, Varese 21026, Italy<br />
Tel: +39 033 2828 443 or 730372 pamisua@tin.it<br />
Ms Sandra O’Shaughnessy, 32 Kilbane Golf Links Road, Castletroy, Limerick City,<br />
Ireland Tel: +353 61 331153, Fax: +353 61 331179<br />
sandra.o’shaughnessy@smith-nephew.com<br />
Ms Angela Parlane, Flat 59, 135 Warwick Road, London, W14 8NJ, England.<br />
Tel: 07810 026534, angelapsyd@hotmail.com<br />
Ms Claudia Parnell, Tissue Viability Specialist, Hawthorn Road Clinic, Hawthorn<br />
Rd, Strood, Kent, ME2 2HU, England<br />
Mrs Elaine Penn, Kent House, Princess Marina Hospital, Upton, Northampton,<br />
NN5 6UH, England Tel: +44 (0)1604 595215<br />
elaine.penn@nht.nhs.uk<br />
Dr Jeanne Perla, 10 Center Road, Orchard Park, New York 14217, USA<br />
Tel: +1 716 662 8662, Fax: +1 716 662 8624 jperla@gaymar.com<br />
Mrs Anne-Marie Perrin, 13 Pettitts Lane, Dry Drayton, Cambs, CB3 8BT, England.<br />
Tel: 01954 780467, Fax: 01954 789729 annemarieperrin@aol.com<br />
Mrs Lyn Phillips, Huntleigh Healthcare, 312 Dallow Road, Luton, LU1 1TD,<br />
England. Tel: 01582 745736, Fax: 01582 459100<br />
lyn.phillips@huntleigh-healthcare.com<br />
Dr Chryssanthi Plati, Univ of Athens, Fragokklissias 12 Str, 15125 Marousi, Athens,<br />
Greece. Tel/Fax: +301 61 98 619<br />
Dr Ivan Poromanski, 21 Macedonia Blvd, Mhatem, Pizogou Clinic of Septic<br />
Surgery, Sofia 1606, Bulgaria Tel: +359 887 439 170, Fax: +359285 173 15<br />
ivan_poromanski@yahoo.com<br />
Mrs Maria Priami, Univ of Athens, Fragokklissias 12 Str, Marousi, 15125 Athens,<br />
Greece. Tel/Fax: +301 61 98 619<br />
Dr Patricia Price, Wound Healing Research Unit, Cardiff Medicentre, Heath Park,<br />
Cardiff, CF14 4UJ, Wales, UK Tel: 02920 682 179, Fax: 02920 754 217<br />
pricepe@whru.co.uk<br />
Mr Nigel Quinn, Pinfold House, Pinfold Lane, Alltami Mold, Flintshire, CH7 6NZ,<br />
England. Tel: 01244 541800, Fax: 01244 547555<br />
nigelquinn@nightingalebeds.co.uk<br />
Dr Steven Reger, Cleveland Clinic Foundation – C21, Dept of Physical Medicine<br />
Rehabilitation, Cleveland, 44195 Ohio, USA<br />
Tel: +1 216 444 1801, Fax: +1 216 445 7000 regers@ccf.org<br />
Mr Claude Regnier, 204 Avenue du Marechal Juin, Boulogne 92104, France.<br />
Tel: +33 141 10 53 00, Fax: +33 144 84 08 44 claude.regnier@bbraun.com<br />
Prof Elia Ricci, Via P. Crotta 8, 10010 Cascinette d’Ivrea, (TO) Italy<br />
Tel: +39 011 544 747, Fax: +39 011 533 649 eliaricci@tin.it<br />
Dr Shyam Rithalia, School of Healthcare Professionals, University of Salford, Brian<br />
Blatchford Building, Salford, M6 6PU, England Tel: 0161 295 2286,<br />
Fax: 0161 295 2302 s.rithalia@salford.ac.uk<br />
Dr Marina Ritter, Polyheal Ltd, 44 Bar Jehuda Str, Nesher, 20300 Israel<br />
Tel: +972 4 820 7917, Fax: +972 4 820 7919 marina@polyheal.co.il<br />
Dr Vladimire Ritter, Polyheal Ltd, 44 Bar Jehuda Str, Nesher, 20300 Israel<br />
Tel: +972 4 820 7917, Fax: +972 4 820 7919<br />
Mr Stefan Roales-Welsch, An der Hauptstr 36, 35287 Amoneburg, Germany<br />
Tel: +49 (0)6421 286 2739 srowe@gmx.de<br />
Dr Marco Romanelli, Department of Dermatology, University of Pisa, Via Roma 67,<br />
56126 Pisa, Italy. Tel: +39 050 992 436, Fax: +39 050 551 124<br />
Ms Marianne Rosager, Brunzevej 1–8, 3060 Espergaerde, Denmark<br />
Tel: +45 49 11 11 11 dkmro@coloplast.com<br />
Mr Joao Carlos Rua Rangel de Lima,12 Pampilhosa Da Serra, 3320–229 Portugal<br />
Tel: +351 235 594 728 miguens.gouveia@clix.pt<br />
Dr David Ryan, GITU Freeman Hospital, Newcastle upon Tyne, NE7 7DN,<br />
England. Tel: +44 (0)191 284311 (x 26423), Fax: +44 (0)191 223401<br />
David.Ryan@nuth.northy.nhs.uk<br />
Dr Paini Salminen-Peltola, Kuusaankuja 2, Jarvenpaa, 04430 Finland<br />
paivi.salminen-peltola@hus.fi<br />
Prof Hiromi Sanada, 5-11-80 Kadatsuno, Kanazawa, Dept of Nursing, School of<br />
Health Sciences, Kanazawa University, 920-0942 Japan. Tel: +81 76 265 2554<br />
Fax: +81 76 234 4363 sanadaf@kenroku.kanazawa-u.ac.jp<br />
Ms Salla Sappanen, Kaarikatu 32, Fin–86300 Culainen, Finland<br />
Tel: +358 50 320 6832 Fax: +358 8 479 3432 salla.sappanen@pp.inet.fi<br />
Miss Susam Sayer, 4 Earlston Place, Edinburgh, EH7 5SU, Scotland<br />
Tel: +44 (0)131 661 4931 suesayer33@hotmail.com<br />
Dr J.M.G.A. Schols, Vlaaikensstraat 2, 4944 XL Raamsdonk, The Netherlands<br />
Tel: +31 162 52 0464 jmga.schols@worldonline.nl<br />
Ms Lisette Schoonhoven, University Medical Center Radboud, Verplegingsweterschap<br />
229, PO Box 9101, 6500 HB Nijmegen, The Netherlands.<br />
Tel: +31 24 361 0458, L.schoonhoven@med.uu.nl<br />
Dr Wayne Schroeder, 8023 Vantage Dr, PO Box 659508, San Antonio, 78265-9508<br />
Texas, USA. Tel: 001 210 554 5396, Fax: 001 210 255 6988 schroedw@kci1.com<br />
Mrs Eileen Scott, Prof. Unit of Surgery, North Tees & Hartlepool NHS Trust,<br />
Stockton on Tees, TS19 8PE, England. Tel: 01642 624087, Fax: 01642 624165<br />
Mrs Pamela Scott, Park View, Bothel, Wigan, Cumbria, CA7 2JD England<br />
Tel: +44 (0)7939 821567<br />
Dr Joseph Selkon, 4 Ethelred Court, Oxford, OX3 9DA, England.<br />
Tel: 01865 764098, Fax: 01865 764098<br />
<strong>EPUAP</strong> MEMBERS<br />
Mrs Catherine Sharp, 3 Salisbury Street, South Hurstville, Sydney 2221, Australia<br />
Tel: +61 2 959 4148 Fax: +61 2 958 50393 catherine 410@hotmail.com<br />
Miss Helen Shearer, 164 Scalby Road, Scarborough, North Yorkshire, TO12 6TB,<br />
England Tel: 01723 3754525 hcs164@hotmail.com<br />
Ms Helen Smyth, Anglia Polytechnic University, School of Healthcare Practice,<br />
24 Park Road, Chelmsford, Essex CM1 1LL, England<br />
Tel: 01245 493131 (x 4142), Fax: 01245 250368 h.smyth@apu.ac.uk<br />
Mr Javier Soldevilla, Agreda Avda de Navarra, 8-10, 4-D, Logrono, 26001, Spain.<br />
Tel: +34 41 251 392, Fax: +34 41 22 03 44<br />
Ms Jackie Stephen-Haynes, Stourport Health Centre, Worcester Street, Stourport<br />
on Severn, Worcs, DY13 8EH, England. Tel: +44 (0)1299 827131<br />
jackies_h@btopenworld.com<br />
Volume 5, Number 3, 2003 109
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Mrs Fiona Stephens, 16 Strangford Rd, Tankerton, Whitstable, Kent, CT5 2EP,<br />
England. Tel: 07711 479668 fiona.stephens@rcn.org.uk<br />
Dr Thomas Stewart, Gaymar Industries Inc, 10 Center Drive, Orchard Park,<br />
NY-14127, USA<br />
Mrs Lesley Stockton, Department of Allied Health Professionals, OT Division,<br />
University of Liverpool, Thompson Yate Building, Brownlow Hill, Liverpool,<br />
L69 3GB, England Tel: +44 (0)151 794 5722, Fax: +44 (0)151 794 5719,<br />
lesley2@liv.ac.uk<br />
Mr Alan Sullivan, Meditec Medical Ltd, Unit 7, Ida Business Centre, Whiteltown<br />
Industrial Estate, Tallaght, Dublin 24, Ireland<br />
Mrs Varda Swager, Hoshav Serufa Doan Nah, Hof Ha Carmel, 30850, Israel.<br />
Tel: +972 4984 2928 Fax: +972 4854 2750<br />
Dr Ian Swain, Dept of Medical Physics and Bio. Engineering, Salisbury District<br />
Hospital, Salisbury, SP2 8BJ, England. Tel: 01722 336262 (x 4065), 01722 425263<br />
Ms Anna-Britta Tallberg, Vaksala Svia, 75594 Uppsala, Sweden, Tel: +46 18 31<br />
7412, Fax: +46 18 611 2460 anna-britta-tallberg@kirurgi.uas.lul.se<br />
Ms Anu Tammemae, Sytiste Str 19, North Estonian Regional Hospital, 13419<br />
Tallinn, Estonia Tel: +372 697 1371, Fax: +372 697 1200<br />
Ms Antje Tannen, Stresowplatz 1, 13597 Berlin, Germany. Tel: +49 30 529 066,<br />
Fax: +49 30 529 900 antje.tannen@charite.de<br />
Dr M Barden ter Haar, BES Rehab Ltd, 9 Cow Lane, Fulbourn, Cambridge,<br />
CB1 5HB, England. Tel: 01223 882105, Fax: 01223 882105<br />
b.e.s.rehab@btconnect.com<br />
Mr Andrew Thelwell, 2 Royal Farm Mews, Edgewell Lane, Eaton, Tarporley,<br />
Cheshire, CW6 9XE, England Tel: +44 (0)1244 584330<br />
Fax: +44 (0)1244 548311 andrew.thelwell@bms.com<br />
Mr Geoff Thompson, Specialist Nurse Manager, Equipment Resource Centre,<br />
Heartlands Hospital, Bordsley Green, Birmingham B9 5SS, England<br />
Tissue Viability Team, Room 15, Chalmers Keddie Building, The Royal Oldham<br />
Hospital, Rochdale Road, Oldham, OL1 2JH, England Tel: +44 (0)161 627 8701<br />
Mr Tore Tomter, Tordivelen 20, Hamar, N-2316 Norway. Tel: +47 625 26272,<br />
Fax: +47 625 21211 tore@togemo.no<br />
Dr Joan Enric Torra i Bou, Galle 5. Bis, Barcelona, 08021, Spain.<br />
Tel: +34 3731 0474<br />
Dr Ciril Triller, Dept of Surgical Infections, Medical Centre Ljubljana, Zaloska 2,<br />
1000 Ljubljana, Slovenia Tel: +386 1 31§ 362 533, Fax: +386 1 522 2398<br />
triller@sirl.net<br />
Mrs Ulla-Maija, Tuuliranta, Purokatu 15B, Fin–40600, Finland.<br />
Tel: +358 14 244 885 mikko.tuuliranta@kolumbus.fi<br />
Ms Geri Usberg, 2 L Punsep St, Tartu University Clinics, Tartu, 51003 Estonia<br />
Tel: +372 566 32818 gerli67@hot.u<br />
Dr Dirk van de Looverbosch, Turnhoutseraan 111, 2100 Deurne, Belgium<br />
Tel: +31 3 325 0965 medresearch@wanadoo.be<br />
Mr Bart Van der Heyden, Houtstraat 74, 9070 Destelbergen, Belgium.<br />
Tel: +32 (0)9356 7222, Fax: +32 (0)9356 6915 bvanderheyden@attyglobal.net<br />
Mr Han van der Mijn, Niewe Achtergracht 100, Amsterdam, 1018 WT, The<br />
Netherlands. Tel: +31 20 624 3079, Fax: +31 20 638 7960<br />
hbjvdmijn@fbadam.nl<br />
Dr Katrien Vanderwee, Ghent University, uz Gent – Blok A 2de V, De Pintelaan<br />
185, Gent, 9000 Belgium. Tel: (and Fax:) +32 9 1240 3694<br />
katrien.vanderwee@rug.ac.be<br />
Mr Edwin Van der Zee, Krommekamp 232, Harderwijk, 3848 DT, The Netherlands<br />
Tel: +31 341 4189214, Fax: +31 341 422957 vanderzee@globalxs.nl<br />
Mrs Tracy Vernon, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, Yorks,<br />
DN2 5LT, England. Tel: 01302 366666 (ext. 3359), Fax: 01302 320098<br />
Ms Heidi Vrijdagh, Huntleigh Healthcare, Stapelplein 70, 9000 Gent, Belgium<br />
Tel: +32 9 265 8770, Fax: +32 9 265 8771 heidi.vrijdagh@huntleigh-healthcare.be<br />
Jan Weststrate, University Hospital Rotterdam, Room H–897 Erasmus Medical<br />
Centre, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands.<br />
Tel: +31 10 463 4237, Fax: +31 10 463 4234 weststrate@aziv.azr.nl<br />
Miss Emma Wheat, 89 Llanishen Street, Heath, Cardiff, CF14 3QD, Wales, UK<br />
Tel: 02920 404729 ewheat@uwic.ac.uk<br />
110<br />
Mr Arthur Wheeler, 1 Samsworth Close, Castor, Peterborough, Cambs. PE5 7BQ,<br />
England. Tel: 01733 380774<br />
Ms Ann Wilson, Tissue Viability Nurse, Queen Margaret Hospital, Whirefield<br />
Road, Dunfermline, Fife, KY12 0SU, Scotland. Tel: 01383 623623<br />
Mrs Ann Withington, 10 Barnfield Crescent, Wellington, Telford, Shropshire<br />
TF1 2ES, England. Tel: 01952 641222 p.a.withington@tesco.net<br />
Mr David Woolfson, Kaymed, Bluebell Industrial Estate, Naas Rd, Dublin 12,<br />
Ireland. Tel: +353 1 419 2999, Fax: 353 1 460 2574 kaymed@kayfoam.com<br />
Mrs Frances Worboys, Block 2, Mile End Hospital, Bancroft Rd, London, E1 4DG,<br />
England. Tel: 020 7377 7873 Fax: 020 7377 7802 fran.worboys@thpct.nhs.uk<br />
Ms Trudie Young, School of Nursing, Glan Clwyd Hospital, Bodelwyddan,<br />
Denbighshire, LL18 5UJ, Wales, UK Tel: +44 (0)1745 534380,<br />
Fax: +44 (0)1745 534960 t.young@bangor.ac.uk<br />
Mr Ireneusz Zbronski, ul Kasztanowa 27, Olsztyn, 10–156 Poland.<br />
Tel: +48 89 533 1013, Fax: +48 89 533 3978 real@real.olsztyn.pl<br />
Volume 5, Number 3, 2003
epuap Membership<br />
EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />
Application Form, 2003–4<br />
MISSION STATEMENT<br />
The <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>’s objective is to provide the<br />
relief of persons suffering from, or at risk of pressure ulcers, in particular<br />
through research and the education of the public. The <strong>European</strong> <strong>Pressure</strong><br />
<strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong> is a registered charity, number 1066856.<br />
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C O R P O R A T E M E M B E R S<br />
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© <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>, 2003<br />
ISSN 1464–7796<br />
Volume 5, Number 3, 2003