Although a pilot, this study has produced a wealth of data that demonstrates the impact of pressure ulcers on people. While a larger study is required to obtain a European perspective, it is still reasonable to conclude that the issues of pain and restrictions should be considered in the development of pressure ulcer treatment and prevention guidelines.

The aim of this study was to explore the lived experience of people who have non-healing venous ulcers using hermeneutic phenomenology. Unstructured interviews were carried out with five people who also completed a diary. Interpretative phenomenological analysis was utilized to identify themes and patterns. The core themes identified through analysis were biographical disruption, ways of coping, social implications and therapeutic relationships. The emergent themes reveal the impact of chronicity in participants' experience of chronic leg ulcers, their various emotional and problem-focused coping strategies and the positive role the district nurse plays in their lives. This study places leg ulceration within the body of literature on chronicity, linking nursing theory with the insights offered from health psychology.

Non healing wounds of the lower limb continue to be a significant issue for both practitioners and patients. Failure of gold-standard management demands a creative response. This article describes the development of a novel and intuitive strapping technique overlying the compression bandage that appears to have an influence in healing complex lower limb ulcers. A retrospective audit of 17 patients with 25 ulcers allows further analysis and discussion. The strapping technique uses cohesive inelastic compression bandaging; narrow strips of bandages are layered in a fan distribution over the ulcer and oedema. This approach seems to offer an intuitive response to these complex wounds, allowing management to be tailored to the site of the ulcer and oedema. Tolerance for this less bulky compression therapy regime is excellent, thereby aiding healing and reducing all costs associated with non healing leg ulcers.

Background and Aims:Immunohistochemistry (IHC) has replaced radioligand binding assay for the determination of oestrogen receptor (ER) status in breast carcinoma. IHC is also used for assessment of progesterone receptor (PR) and HER2. The Royal College of Pathologists of Australasia (RCPA) Quality Assurance Program (QAP) introduced a breast markers module in 2003 to evaluate the performance of laboratories with IHC for ER, PR and HER2.Methods:An audit of laboratories reporting breast carcinomas was performed in 2005 and 2006 to evaluate in-house results. Laboratories were asked to submit the hormone receptor and HER2 status on each invasive breast carcinoma for the previous 6 month period up to a maximum of 100 cases. The time periods were 1 July 2004 to 31 December 2004, and 1 July 2005 to 31 December 2005. A total of 55 laboratories returned information for 2004 and 67 for 2005.Results:Complete data on 8128 patients was returned for both surveys, 3353 cases for 2004 and 4775 for 2005. The results were similar for both surveys. Of the 8128 cases, 59.0% were ER+/PR+, 15.9% ER+/PR−, 2.4% ER−/PR+ and 22.7% ER−/PR−. HER2 data were submitted for a total of 6512 patients (excludes 52 patients with incomplete data sets); 17.1% were reported as 3+ positive on IHC, 12.5% as 2+ and 70.4% as negative.Conclusions:A laboratory audit was introduced into the RCPA QAP for breast markers due to concerns raised by participating laboratories about technical differences in supplied tissues for testing. This audit indicates that overall the results for ER, PR and HER2 fall inside established parameters. However, a number of individual laboratories do not meet the target values and variation in results would impact on patient treatment decisions.

The academic literature reveals a dearth of evidence regarding the wound prevalence across a community setting, despite the need for both clinicians and commissioners to understand local need. To support the commissioning process, a wound prevalence audit was undertaken across all community services in an inner London borough in 2012 as part of a local needs analysis and to identify where resources were required. Within a population of 254,000, 272 residents had a total of 325 wounds, giving a mean of 1.19 wounds and a community wound prevalence of 1.07 per 1000 residents. The majority were male (51%) and the age range was 9e96 years. Acute and traumatic wounds accounted for 44% followed by foot and leg ulcers at 41%, pressure ulcers at 13% and other wound types at 2.6%. Of the lower leg ulceration group, 34 patients had venous ulceration, giving a prevalence of 0.13 per 1000. The difficulties in establishing a comprehensive wound prevalence that includes acute services are discussed in addition to the significance of the findings in the context of a deprived ethnically diverse borough with a younger population. The number of residents with any wound type was lower than other reported studies with similar methodologies. This paper presents the view that, despite the deprivation of the borough, the combined factors of age, ethnicity and early access to specialist expertise appear to deliver a lower community wound prevalence.

High compression is the gold standard for venous ulcer management. This brief report presents the results of a sub-bandage pressure study that investigated the pressures received from compression therapy in the region of the retromalleolal fossa. The study tested the hypothesis that therapeutic compression is not achieved behind the malleolus. The results confirm this, showing that less that 5-mmHg sub-bandage pressure is achieved despite high compression at the B1 level. This report demonstrates that the application of novel strapping below the malleolus substantially increases the compression at rest, standing and dorsiflexion. The clinical implications of this are discussed.

Introduction and description of care: The management of non-healing wounds in Europe has gone through a dramatic shift in the location of service delivery from hospital towards home care settings. As a consequence more wounds with complex pathological pictures due to untreated patient co-morbidities are treated at home. There are no guidelines available covering the subject of home-care wound-management from a clinical perspective as well as no recommendations of minimal requirement of providing best care and supporting the empowerment of informal carers and patients with non-healing wounds in the home-care setting.

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