{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:23:13Z","timestamp":1791872593037,"version":"4.3.4"},"reference-count":57,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100012358","name":"National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012358","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,2,12]]},"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complex wounds impose a substantial health economic burden worldwide. As wound care is managed across multiple settings by a range of healthcare professionals with varying levels of expertise, the actual care delivered can vary considerably and result in the underuse of evidence-based interventions, the overuse of interventions supported by limited evidence and low value healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify the number, type and management of complex wounds being treated over a two-week period and to explore variations in care by comparing current practices in wound assessment, prevention and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multiservice cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This survey spanned eight community services within five Northern England NHS Trusts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The point prevalence of complex wounds in this community-based population was 16.4 per 10\u2009000 (95% CI 15.9 to 17.0). Based on data from 3179 patients, antimicrobial dressings were being used as the primary dressing for 36% of patients with complex wounds. Forty per cent of people with leg ulcers either had not received the recommended Doppler-aided Ankle Brachial Pressure Index assessment or it was unclear whether a recording had been taken. Thirty-one per cent of patients whose most severe wound was a venous leg ulcer were not receiving compression therapy, and there was limited use of two-layer compression hosiery. Of patients with a pressure ulcer, 39% were not using a pressure-relieving cushion or mattress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Marked variations were found in care, underuse of evidence-based practices and overuse of practices that are not supported by robust research evidence. Significant opportunities for delivering better value wound care therefore exist. Efforts should now focus on developing strategies to identify, assess and disinvest from products and practices supported by little or no evidence and enhance the uptake of those that are.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-019440","type":"journal-article","created":{"date-parts":[[2018,3,23]],"date-time":"2018-03-23T02:35:19Z","timestamp":1521772519000},"page":"e019440","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":116,"title":["Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8088-0698","authenticated-orcid":false,"given":"Trish A","family":"Gray","sequence":"first","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Rhodes","sequence":"additional","affiliation":[{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"},{"name":"Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross A","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Rothwell","sequence":"additional","affiliation":[{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wilson","sequence":"additional","affiliation":[{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"},{"name":"Alliance Manchester Business School, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo C","family":"Dumville","sequence":"additional","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicky A","family":"Cullum","sequence":"additional","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK"},{"name":"Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,3,22]]},"reference":[{"key":"2025101810453763000_8.3.e019440.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/pgfar04130","article-title":"Wounds research for patient benefit: a 5-year programme of research","volume":"4","author":"Cullum","year":"2016","journal-title":"Programme Grants for Applied Research"},{"issue":"Suppl 2","key":"2025101810453763000_8.3.e019440.2","first-page":"S6","article-title":"Complex wound or complex patient","volume":"10","author":"Vowden","year":"2005","journal-title":"Internursecom"},{"key":"2025101810453763000_8.3.e019440.3","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/wrr.12230","article-title":"Point prevalence of complex wounds in a defined United Kingdom population","volume":"22","author":"Hall","year":"2014","journal-title":"Wound Repair Regen"},{"key":"2025101810453763000_8.3.e019440.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-009283","article-title":"Health economic burden that wounds impose on the National Health Service in the UK","volume":"5","author":"Guest","year":"2015","journal-title":"BMJ Open"},{"key":"2025101810453763000_8.3.e019440.5","unstructured":"Graves N , Zheng H . 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