John Gregory

http://myiiwccselective.blogspot.com

A Blog as an Enabler for Practice for Lower Limb Assessment

Purpose: Future development:
“The most rewarding research is the one that delights the thinker and at the same time is beneficial to humankind.”
D emystifying Ankle Brachial pressure Index (ABI) assessment through the
dissemination of interactive enablers was chosen as a selective for the International
Interprofessional Wound Care Course (IIWCC) through the University of Toronto. The need
(Christian Doppler, 1803-1853)
On reflection and for the future, a Wiki may
be more valuable rather than a blog. A
blog has some notable limitations. Readers
for a simple tool to enable wound care practitioners to confidently conduct ABIs was which included original papers, recommended literature and international best itself was the enabler. It allowed multimedia files such as audio and video files to be can add comments on a blog but cannot
identified. The aim of the work was to make audio and video resources more widely practice recommendations. A selection of authors and educators in the field of uploaded along with immediate interactive discussion and feedback. The use of a blog upload information to it. A blog also lists
available to healthcare professionals in one easy to access central location, through vascular assessment and leg ulceration were consulted in order to gain further guidance was evaluated amongst the responders and the development of a blog researched as a all entries in reverse chronological order.
a blog as an educational enabler. and literature/best practice recommendations. Copies of identified papers/guidelines viable enabler to practice. Wikis are often used to create collaborative
were obtained and reviewed. Finally, research was conducted through online search websites and to power community
The need for vascular engines including MedLine, PubMed, Google Scholar and the Cochrane Database. The The use of a blog as an enabler to practice: websites. The collaborative encyclopedia,
assessment: literature was not weighted through the AGREE instrument or critically appraised. Wikipedia, is one of the best-known wikis.
WoundPedia (www.woundpedia.com) is a wonderful new wound care resource launched Wikipedia – http://en.wikipdia.org/wiki/Blog defines a blog as (an abridgement of the Transferring the current blog to a wiki would
Kevin Woo et al stated in a 2007 audit of at the World Union of Wound Healing Societies 2008. It includes a systematic review term web log) a website, usually maintained by an individual, with regular entries of enable others to upload files to the site,
leg and foot ulcer care in Ontario that by Mario Caruana et al which includes significant information about ABI and its value incommentary, descriptions of events, or other material such as graphics or video. The thereby making it a more interactive tool for all readers and allow many users to ask
approximately 30% of the clients in both evaluating people with venous leg ulcers and asymptomatic peripheral vascular disease . ability of readers to leave comments in an interactive format is an important part of many
5 and answer questions. The content of the wiki can also be organized as desired and so
Toronto (29%) and Peel (32.7%) who Summaries of the literature reviewed are posted at: http://myiiwccselective.blogspot.com.
blogs. It was the ability to upload text, audio and video files that was the deciding factor for the most valuable links and resources can be shown first, rather than with a blog where
received community care for ulcerations using a blog as an enabler for this selective. The audio files of arterial and venous sounds, entries are only listed chronologically.
did so without a diagnosis of the ulcer Understanding obstacles and challenges of and video files of correct ABI technique were already in existence and it was beyond
etiology in their records . Similar
1
Implementing ABI in practice settings: the scope of this current work to create new audio and video files; thus it was simply a Conclusion:
percentages were receiving high matter of using the blog as a means to host these existing files. The site Blogger, owned
Lower limb ulceration is a significant
compression using multi-layer bandaging In order to fully understand current practice and the obstacles and challenges to the by Google, was chosen to host the proposed web log (blog) as this is a very popular
systems. As well the majority of subjects had not undergone any known special site www.blogger.com. Unfortunately, there are burden both to the patient and the
implementation of best practice, research was
vascular testing (Peel 48.1% and Toronto 58.6%). Christine Moffat & Peter Franks some technical limitations to Blogger as Word, health care system. Both the RNAO and
needed amongst healthcare professionals. It
report a high proportion of patients with unspecified ulcer etiology, noting that the was decided that this would be done by survey Survey Results Actual # Percentage % Excel, PowerPoint or PDF files cannot be CAWC best practice guidelines stress
level of assessment was poor suggesting that the etiology of ulceration was unproven Total sample of uploaded directly. These documents can be the importance of initial thorough patient
of approximately 160 IIWCC students. This
in most cases2. There are poor implementation protocols despite the availability respondents 160 100% shared through a document hosting site and history and physical examination of the
course is run under the auspices of the
of best practice guidelines or recommendations developed by the Registered Nurses’ then a hyperlink placed in the blog entry. Files of patient. The assessment of Ankle Brachial
University of Toronto and Women’s contacted
of Ontario (RNAO) and CanadianAssociation of Wound Care (CAWC)3,4. The this nature were placed online through Scribd, Pressure Index with the use of a hand-held
College Hospital. Consequently it was agreed Respondents
literature consistently recommends a complete diagnostic assessment for patients with 35 22% www.scribd.com, described as a big online Doppler is a simple technique that with
between the author and Faculty that application
lower extremity ulcers including an Ankle Brachial Pressure Index (ABI) to detect should be made to the Research Ethics Board (by July 25 2008) library where everyone can publish original good training and implementation in clinical
arterial disease. ABI can be relatively inexpensive and easily assessed with a Surveys fully content. The Google hosting site was also practice should be performed routinely as
(REB) at Women’s College for ethics approval of 25 of 35 83% used to directly upload audio files and video files. part of any lower limb assessment and should
hand-held Doppler. There are a number of simple enablers which help clinical staff the survey. The drafted survey was discussed completed
cross-reference the ankle and brachial pressures to indicate the pressure index. Whilst the assist in decision making. This selective
with the Faculty and international key opinion Professional role as
technique is fairly easy and very well documentedin the literature it is not one with leaders at the World Union of Wound Healing 19 of 35 54% Enabler feedback: involved the use of a blog as an enabler to
wound care nurses practice. The blog development and survey amongst IIWCC students demonstrated that
which many healthcare professionals are familiar or use regularly. There appears to be a Societies to verify the appropriateness of the
gap in the literature on enablers for conducting ABI examinations. Enablers currently e questions. A clear invitation email was sent to the Use ABI before Enabler feedback consisted of comments from this new online medium can be a viable means to promote interaction in the knowledge
xist but they are company sponsored and are not cited in the literature. A wider applying 24 of 31 77% wound care specialists, IIWCC Faculty and translation. The blog has successfully made audio files of arterial and venous sounds, as
respondents to explain the nature of the survey,
distribution of enablers needs to be made available to assist with the wider students and healthcare communications well as videos of best practice in conducting ABIs, available to healthcare professionals
the voluntary nature of completing it and how compression on the internet. A blog has some limitations and a Wiki may be a more interactive
implementation of ABI examinations. the results would be used. The survey asked experts. It is a work in progress and the
respondents for their professional role, Experience of improvement of the blog enabler will be medium. http://myiiwccselective.blogspot.com.
16 of 35 46%
Literature review of ABI: country and experience/knowledge in conduction ABI ongoing. Some of the comments have related to
conducting ABIs. The survey was sent Usage of CAWC/RNAO improvements in the appearance, the addition
Literature searches were conducted by email to the current 80 IIWCC Best Practice 30 of 39 77% of a biography, a better description below the References:
through a number of sources. 2007-2008 students and to the 80 title in the purpose of the blog. There has been
Guidelines feedback in respect to any errors on the site or 1. Woo K, Lo C, Alavi A, Queen D, Rothman A, Woodbury G, Sibbald M, Noseworthy P, Sibbald RG. An audit of leg
1) Huntleigh Diagnostics in Cardiff previous IIWCC students from the 2006-2007
2) Opinion leaders in the field year. The IIWCC group was comprised from a Conduct repeat within difficulties with the navigation of links. There have and foot ulcer care in an Ontario community care access centre. Wound Care Canada 2007;5(1):S17-S27.
25 of 35 71% 2. Moffat CJ, Franks PJ. Epidemiology and Health Services Research: Implementation of a leg ulcer strategy.
3) Best Practice Guidelines/ mixed professional role, different countries and one year also been comments posted with suggestions to B J Derm. 2004;151:857-867.
Recommendations & Consensus levels of skill and experience. No use of enabler 13 of 28 46% the content or recommendations for additional 3. Registered Nurses1 Association of Ontario (RNAO). Nursing Best Practice Guideline: Assessment and
Documents Slight benefit or links or references. There has been significant Management of Venous leg Ulcers. Toronto: RNAO. 2004.
4) Online research Enabler development: interest in audio and video files being added to 4. Burrows C, Miller R, Townsend D, Bellefonatine R, MacKean G, Orsted L et al. Best Practice Recommendation for
significant benefit of the blog. The intention is for the blog to remain the Prevention and Treatment of Venous Leg Ulcers: Update 2006. Wound Care Canada. 2006;4(1):45-55
5) WoundPedia 5. Caruana MF, Bradbury AW, Adam DJ. The Validity, Reliability, Reproducibility and Extended Utility of Ankle to
The blog was initially a mechanism to document online multimedia as an 20 of 26 72% up and running in the long term and that the Brachial Pressure Index in Current Vascular Surgical Practice. European Journal of Vascular & Endovascular
Huntleigh Diagnostics were willing the process of the development of the selective; enabler to content will be updated continuously. Surgery 2005;29:443-451
to share their library of papers on however, it soon became obvious that the blog knowledge translation Contact: john.gregory@arjo.ca
diagnostic ultrasound relating to ABI,
The IIWCC program & poster were supported by an educational grant from ArjoHuntleigh Canada Inc. where John Gregory is Marketing Director.