Predicting Healing: Rethinking Venous Leg Ulcer Care with Professor Christina Parker: täielik transkriptsioon

point where I thought, I'm sure we can do better. 00:02:52.719 --> 00:03:06.719 Um, and I didn't necessarily look for a wound care group at university, but it was always in the back of my mind that, you know, this is an area that's really important, and you know, there's a lot of research that we can be doing. 00:03:06.960 --> 00:03:09.439 So yeah, it really drew me in. 00:03:09.759 --> 00:03:10.639 Yeah, I love that. 00:03:10.719 --> 00:03:12.719 I don't know that any of us look for wound care. 00:03:12.960 --> 00:03:15.759 We all fall into the career path for sure. 00:03:16.000 --> 00:03:25.520 So uh was there a particular perhaps patient experience or problem that made you think there is something we need to understand better in this field? 00:03:26.159 --> 00:03:35.120 Yeah, there's probably one patient that stands out, and it's been a long time since I was in general practice, and yet I still remember this particular case. 00:03:35.280 --> 00:03:38.319 So it obviously really made an impact on me. 00:03:38.400 --> 00:03:46.560 And it was a a man that had a diabetic foot ulcer at the time, and we were dressing it, we were dressing it every couple of days. 00:03:46.800 --> 00:03:56.960 He kept coming back in, and then we sent him off to hospital, and I never really knew what happened because in general practice, you know, you're just so busy all the time. 00:03:57.039 --> 00:04:03.599 And it wasn't until down the track that I learned that he'd actually lost his limb um due to that wound that we'd been treating. 00:04:03.759 --> 00:04:12.159 And I think that's what really stayed with me that we we can do better, we should be able to do better. 00:04:12.240 --> 00:04:16.639 Um, and that, yeah, it was really the impetus to wanting to change. 00:04:17.759 --> 00:04:23.439 It's devastating when we have patients that have to have such life-changing outcomes. 00:04:23.680 --> 00:04:30.639 So, all right, Christina, one of the things we like to start with on Wound Care Unwrap is a session week called Clinical Confessions. 00:04:30.879 --> 00:04:39.199 So I want to ask, you know, you've been working in the field for over 30 years, you had some clinical experience, research, and certainly in the education space. 00:04:39.439 --> 00:04:55.839 Was there something you believe, or if you think about that you have seen in this area where maybe your research has made you think, boy, we could do better in that space, or are we still missing certain areas of the work we do for wound care and patients? 00:04:56.959 --> 00:05:10.160 Well, I think the change that I've seen, um, and you know, this is something I didn't do very well when I was first starting out, was really thinking more holistically, more than just the wound itself. 00:05:10.399 --> 00:05:20.319 Like we know that there's other impacts and other risk factors on people getting a wound in the first place, but also then being able to heal that wound as well. 00:05:20.480 --> 00:05:26.319 So, you know, I

used to care for a wound in general practice and I'd look at the size of it and the axiod. 00:05:26.800 --> 00:05:30.160 And but did I ever think about the nutrition? 00:05:30.399 --> 00:05:37.199 Did I ever think about whether that person, um, you know, how much was it going to cost to look after the wound? 00:05:37.600 --> 00:05:42.160 You know, did they have somebody at home with them to help them out with some of the wound care? 00:05:42.560 --> 00:05:47.199 That's, I think, um, the change, and that's the thing I think we need to think more about. 00:05:48.560 --> 00:05:56.399 And so just pushing that a little step further, you know, holistic health care is is one area that, yes, we must focus on a lot more. 00:05:56.560 --> 00:06:01.600 But have you come across things that make you think, geez, we should know better by now? 00:06:01.759 --> 00:06:02.800 We shouldn't be doing that. 00:06:02.879 --> 00:06:04.639 Is there anything that sticks out? 00:06:06.319 --> 00:06:16.560 I think um, you know, we have evidence summaries, we have guidelines, and how are we actually implementing them into practice? 00:06:16.720 --> 00:06:19.040 Like, I don't think we've got that yet. 00:06:19.199 --> 00:06:26.319 And when we look at the literature, it says um that it takes 15 years to get evidence into practice. 00:06:26.480 --> 00:06:32.560 That's too long for our patients who need that evidence right now. 00:06:32.879 --> 00:06:46.000 And so a lot of the work that we've done, and this is why we have people like implementation scientists these days, we have frameworks on trying to get implementation um of you know the evidence that we've been able to find in research. 00:06:46.160 --> 00:06:50.319 But I think, you know, that's what we need to be doing better. 00:06:51.439 --> 00:06:52.959 I want to um tap into that. 00:06:53.120 --> 00:06:57.199 15 years, if that's what the research is showing, we've got a way to go. 00:06:57.439 --> 00:07:00.399 Is there any immediate barriers that you can think of? 00:07:00.560 --> 00:07:05.920 What's stopping us from, you know, we get these fantastic guidelines that experts in the field pull together for us. 00:07:06.000 --> 00:07:07.600 They're they are digestible. 00:07:07.680 --> 00:07:14.000 I get that not everybody wants to read the big thick ones, but what's stopping us from implementing them, do you think? 00:07:15.600 --> 00:07:26.000 I think it's um it's awareness of the guidelines, and there are a lot of them, you know, a lot of different organizations develop a guideline. 00:07:26.160 --> 00:07:33.680 I think it would be nice to see internationally we work together a lot more to come up with guidelines. 00:07:33.839 --> 00:07:54.319 One of the things that, you know, we've done in one of the research projects that we've got is try to pull together some of those guidelines in a two, three, or four-page guideline document that's really easy for clinicians to pull out when they need it because they don't have the

time either to be going and looking up a number of different resources. 00:07:54.560 --> 00:08:05.040 But, you know, we also need that education as that bottom line as well, to know that there are these resources out there that can help guide our practice. 00:08:05.360 --> 00:08:10.800 Yeah, I think you you've really touched on one of the main barriers is is knowing that they're available. 00:08:10.959 --> 00:08:18.240 So coming together globally, you know, we are all in the same place, we all have the same problems, people are living with wounds all over the world. 00:08:18.399 --> 00:08:19.680 Maybe that's a way forward. 00:08:19.839 --> 00:08:22.879 Christina, please, I challenge you to set something up globally. 00:08:22.959 --> 00:08:23.920 I'd be involved. 00:08:24.160 --> 00:08:27.680 The most expensive wound is the one that doesn't heal. 00:08:28.000 --> 00:08:34.480 Every extra week means more dressings, more nursing time, more time and more cost. 00:08:35.039 --> 00:08:52.559 Published evidence shows the gecko muscle pump activator can improve healing alongside standard care, while health economic analysis have also demonstrated reductions in nursing visits and dressing costs, because the best way to reduce the cost of wound care is to heal the wound. 00:08:52.720 --> 00:09:01.840 If you'd like to learn more or bring gecko into your own practice, you can find it through Lightly Medical, the Australian distributor at lightlymedical.com.au. 00:09:02.399 --> 00:09:08.080 Let's dive in a little bit to your PhD, which I have to say I have read it and it's fantastic. 00:09:08.240 --> 00:09:11.120 I have learnt stuff that I didn't even realise I didn't know. 00:09:11.200 --> 00:09:12.159 So well done. 00:09:12.320 --> 00:09:21.919 Um, and I have to say, looking at your PhD, do you think we can predict which venous leg ulcers are at risk of not healing? 00:09:22.000 --> 00:09:26.879 And why do we need a risk assessment tool for venous leg ulcers, in your opinion? 00:09:27.279 --> 00:09:32.559 I think the risk assessment tool that we put together was really it was robustly designed. 00:09:32.639 --> 00:09:36.879 So it was based on very large databases of information. 00:09:37.039 --> 00:09:41.200 It was based on um literature reviews looking at all the risk factors. 00:09:41.440 --> 00:09:45.360 We had an expert advisory group that helped put it together. 00:09:45.519 --> 00:10:04.799 Um, and we've been able to show with about between 80 and 90% accuracy that we can determine whether somebody with a venous leg ulcer will heal within that, you know, sort of 24-week time frame, which is sort of you know what we gauge as most people should be healed within. 00:10:05.200 --> 00:10:07.440 Um, I think that then guides our practice. 00:10:07.600 --> 00:10:15.200 If we know that somebody's gonna heal within a certain time, then that guides the management strategy that we're gonna put in place. 00:10:15.440 --> 00:10:25.759 If somebody is at a high risk

of not healing within that time frame, what do we need to think about right at the very start or within that first two-week window? 00:10:26.000 --> 00:10:33.200 Because the the risk assessment tool looks at baseline um scoring and also two-week scoring as well. 00:10:33.440 --> 00:10:48.879 At that two-week mark, really early on, do we need to be considering something extra in that management space that's gonna help push that wound along to heal quicker than it might otherwise do? 00:10:50.960 --> 00:10:59.840 Your research also identified factors associated with non-healing, including inadequate compression, wound severity, early wound area reduction. 00:11:00.000 --> 00:11:05.279 And really interestingly, I really liked the part of living alone as well as a problem. 00:11:05.600 --> 00:11:12.879 Where were there any findings that say surprised you, particularly the importance of factors outside the wound itself? 00:11:14.320 --> 00:11:29.600 I guess it didn't surprise me, but what surprised me was this was the first study that it ever found that somebody that lived alone was at risk of not healing within a timely way. 00:11:30.240 --> 00:11:43.519 Um so, you know, there's some other psychosocial um literature that that supports some things, but you know, this living alone, and when you think about it, it makes a lot of sense. 00:11:43.679 --> 00:11:59.120 And in my PhD at the end, I was sent back um before they would tick off the final um PhD to think about what might it be about people that live alone that contributes to this delayed healing. 00:11:59.360 --> 00:12:08.320 So is it potentially that um those people don't have the same nutrition, they don't eat as well as as somebody else? 00:12:08.480 --> 00:12:10.399 Is it about the social support? 00:12:10.559 --> 00:12:18.960 Although the literature says that just because somebody lives alone doesn't necessarily mean they have low social support either. 00:12:19.519 --> 00:12:32.480 So to me, it's I think that was the most important part of my PhD because as clinicians, we can we know that yeah, we can put compression on somebody and that's gonna help them heal. 00:12:32.720 --> 00:12:40.159 But what intervention do we need for people who live alone that's gonna help with this type of healing? 00:12:40.320 --> 00:12:42.399 Is there anything that we can do? 00:12:42.960 --> 00:12:53.360 Did did your findings um, you know, did you come up with any anything further around why that isolation caused these wounds to last a lot longer? 00:12:53.519 --> 00:12:56.000 Did you find anything in your research? 00:12:56.559 --> 00:12:58.879 Nothing in my research. 00:12:58.960 --> 00:13:01.120 Uh I have sort of ideas. 00:13:01.440 --> 00:13:20.080 Um, you know, if somebody lives with somebody else and they've got the ability for that other person to help with putting on and off compression, um, with being able to help with managing dressings and that, rather than somebody who lives alone and is very reliant on people coming to the house. 00:13:20.159 --> 00:13:30.240 And there's this sort of window time that they have to be available to get that dressing done, you know, does that impact on that wound being able to heal? 00:13:30.320 --> 00:13:38.240 I mean, they may take their bandages off very early in the morning and wait for a community nurse to come, which may be a couple of hours. 00:13:38.480 --> 00:13:46.879 Um, so I think there's there's thoughts, but as for um literature to support that, it is just all my thoughts. 00:13:47.200 --> 00:13:50.159 So I'm hearing more research to be done. 00:13:50.960 --> 00:13:56.960 Uh I think there's something in that, but um, and I'd love to work on this with you because it's an interest area of mine. 00:13:57.200 --> 00:14:05.519 Almost a like a checklist of what to think about for that person living at home for healthcare providers looking after them that you should be going through. 00:14:05.679 --> 00:14:09.200 Can do they have a device to put their compression on? 00:14:09.360 --> 00:14:12.639 Um, what's the time frame that the nurse might come in? 00:14:12.799 --> 00:14:15.279 Could you leave it on the compression until they arrive? 00:14:15.440 --> 00:14:22.159 I also wonder if, you know, around their house, which is often smaller, if they're maybe not getting up and walking as far as they should. 00:14:22.240 --> 00:14:28.960 And we know it's the activation of the muscle pump that gets the support of healing the wounds as, I mean, I could go on and on. 00:14:29.039 --> 00:14:31.360 You've got me interested now, um, Christina. 00:14:31.440 --> 00:14:32.159 This is great. 00:14:32.320 --> 00:14:34.799 Anyway, we'll have to take that one offline. 00:14:35.200 --> 00:14:41.759 One of the um really practical findings was um looking at wound area reduction early in treatment. 00:14:41.840 --> 00:14:43.759 That was a really interesting read. 00:14:44.000 --> 00:14:48.639 How early should we expect to see progress in a venous leg ulcer? 00:14:48.720 --> 00:14:54.000 And when should we, should it maybe a lack of progress trigger a rethink or diagnosis? 00:14:54.480 --> 00:15:06.000 Yeah, look, you know, most of the literature and most of what we've been working with for years is at four weeks we should reconsider our management plan if there hasn't been a reduction in the wound size. 00:15:06.080 --> 00:15:10.480 And the literature is a little bit varied in what that reduction should look like. 00:15:10.720 --> 00:15:27.120 What we were able to find was that there was um, you know, if a wound hadn't reduced in size by 25% within two weeks, um, that was a significant predictor that that wound was then not going to heal in a timely way. 00:15:27.279 --> 00:15:31.840 So I think we can do it in half the time that we've been previously doing. 00:15:32.000 --> 00:15:39.279 Like at that two-week mark, it's important to be looking at, you know, has it reduced by this time frame? 00:15:39.440 --> 00:15:42.639

If not, what do we need to be considering? 00:15:42.879 --> 00:15:44.240 What might we be missing? 00:15:44.399 --> 00:15:50.799 Have we done all the assessment that we need to do to then be able to put a management strategy in place? 00:15:51.759 --> 00:16:01.679 That's really interesting because you know, you look at some of the other studies and often they'll talk about 30% or 40%, but over a four-week period, and you've just said 25% over two weeks. 00:16:01.840 --> 00:16:03.679 That's really interesting findings. 00:16:03.919 --> 00:16:11.279 So, look, we talk a lot about these validated tools and you know, evidence-based practice, but we have to say every patient is different. 00:16:11.519 --> 00:16:17.679 How do we balance a risk assessment score with clinical judgment and person-centered care? 00:16:18.559 --> 00:16:24.480 I think if you look at the evidence-based um framework of what we need to include. 00:16:24.559 --> 00:16:38.559 So you've got your clinical guidelines, which would include your risk assessment tools as well, but it always has to come along with um clinician skills, clinician knowledge, and also the individual with the wound as well. 00:16:38.799 --> 00:16:41.279 So every person is different. 00:16:41.519 --> 00:16:43.759 What their goals are may be different. 00:16:43.919 --> 00:16:51.759 I often talk about um, you know, I think sometimes as clinicians, our first go-to is we want to heal this wound. 00:16:52.080 --> 00:16:56.480 But for this person that's sitting in front of me today, is that their goal? 00:16:56.639 --> 00:17:08.799 And I always refer to the example of um a person that I had that had a wound, and she was her only outing for the week was to go to the local coffee shop with her friends. 00:17:09.039 --> 00:17:15.279 And she was asked to leave that coffee shop because of the odor and the exudate that was coming from her wound. 00:17:15.920 --> 00:17:29.359 And I think for that person, at that particular point in time, her goal was not to heal, it was to reduce the exudate and the odor so that she could continue to do what she did every week. 00:17:29.519 --> 00:17:38.480 And so I think it's really important when we think about that evidence-based framework that that there are all those parts to it, and that's what makes it person-centered. 00:17:38.799 --> 00:17:44.880 It is not just about the guidelines, not just about the risk assessment tool, but it's all part of it. 00:17:46.480 --> 00:17:47.359 You're so right. 00:17:47.519 --> 00:17:52.559 I remember 25 years ago in this industry, the question was always asked, what is your goal of care? 00:17:52.640 --> 00:17:53.680 And you really had two options. 00:17:53.759 --> 00:17:57.519 Are we going to heal or are we looking at conservative palliative wounds? 00:17:57.680 --> 00:18:00.240 Boy, we've come a long way on the journey to your point. 00:18:00.319 --> 00:18:01.440 We're dealing with people. 00:18:01.680 --> 00:18:02.640 And maybe Mrs. 00:18:02.720

--> 00:18:06.640 Smith just wants to go back down to that coffee shop without the dressing leaking through. 00:18:06.799 --> 00:18:13.119 So you've hit the nail on the head there and work out what your patient wants and what's important to them. 00:18:13.359 --> 00:18:23.119 Do you think there's a danger, but that clinicians sometimes become too focused on completing the tool rather than understanding why this particular person's wound isn't healing? 00:18:23.279 --> 00:18:31.359 And I have to ask a little bit about at what point do these tools become a little bit too subjective, what you might say, I might say different when I'm completing it. 00:18:31.440 --> 00:18:32.720 What are your thoughts? 00:18:33.200 --> 00:18:36.880 Oh, I I absolutely think there's a risk of us relying on tools. 00:18:36.960 --> 00:18:58.000 And when you look at some of the other tools that we've got in practice and the reliance on, you know, what that score is and then what you do without really thinking about what the context of that score is and and whether it really is, and also thinking about what their score was potentially previously. 00:18:58.240 --> 00:19:06.640 Um, you know, there's some things on that tool that we can um modify, but there's other things that you can't. 00:19:06.720 --> 00:19:09.279 You can't change a person's age, for example. 00:19:09.920 --> 00:19:18.720 But you can modify whether or not they wear compression, or you could help educate them on being able to make that that um decision. 00:19:18.799 --> 00:19:22.240 But at the end of the day, it is their decision to make. 00:19:22.480 --> 00:19:32.319 So I think educating with the tool, instructions and knowledge that comes with using that tool is absolutely crucial. 00:19:32.480 --> 00:19:38.000 Otherwise, we are going to have reliance on the tool that's um it it won't work. 00:19:38.400 --> 00:19:45.359 Yeah, and look, it can guide your practice, and a tool is there to help you um, you know, support the patient as best you can. 00:19:45.599 --> 00:19:52.799 Now, if I think about your research, it also identified lower levels of compression as an important predictor of non-healing. 00:19:52.960 --> 00:19:58.480 You know, when we talk about compression, we're often talking about, you know, the ideal being 40 millimeters of mercury. 00:19:58.880 --> 00:20:07.599 Given how much evidence we now have for compression, why do you think we're still seeing venous leg ulcers treated without adequate compression? 00:20:07.920 --> 00:20:17.839 I think there's still um I think people are still there's a lack of education to start with. 00:20:18.000 --> 00:20:24.160 I think in all our health professional courses, there's very little wound care education. 00:20:24.559 --> 00:20:36.559 And we are trying to address that, but a lot of the the wound education is done in the postgraduate space, and people are already in practice at this point, they're already looking after people. 00:20:37.200 --> 00:20:48.079

I think people are still a little scared of compression because if you get it wrong, um, it can go really wrong for patients. 00:20:48.319 --> 00:20:59.599 But to me, that then comes back to assessment being almost the gold standard part of the care of a person with a wound. 00:20:59.680 --> 00:21:02.000 It's not the management so much. 00:21:02.240 --> 00:21:07.359 The management has to follow a proper assessment to start with. 00:21:07.440 --> 00:21:14.160 And if you get your assessment right, then you've got confidence in that you're applying compression in the right way. 00:21:14.480 --> 00:21:16.799 Um, and then of course, we come back to the guidelines. 00:21:16.960 --> 00:21:18.799 Yes, we have all these guidelines. 00:21:18.960 --> 00:21:25.759 How well are we getting that information out into practice to the clinicians on the ground that are caring for these people? 00:21:26.079 --> 00:21:28.000 Back to the implementation science. 00:21:28.160 --> 00:21:28.799 Absolutely. 00:21:29.039 --> 00:21:41.359 Do you do you think there's also an element of we are focused or clinicians are too focused on what dressing should I put on this wound, as opposed to how do I adequately treat the underlying venous disease? 00:21:41.759 --> 00:21:42.400 Absolutely. 00:21:42.559 --> 00:21:54.400 I think you know, there's almost never an education session that I do where somebody doesn't come up to me afterwards with a photo of a wound and says, What dressing do I need to put on this wound? 00:21:54.799 --> 00:21:59.759 It's the first question that anybody asks, and yet, you know, you can. 00:22:00.319 --> 00:22:11.839 Almost put a variety of dressings on, um, and each would equally work as well without that compression, it's never going to heal that wound. 00:22:11.920 --> 00:22:17.440 And we know that for venous leg ulcers, compression is the gold standard treatment, or we should know that. 00:22:17.599 --> 00:22:19.839 Um, so I I totally agree. 00:22:20.000 --> 00:22:24.960 I think you know, there is too much emphasis on which dressing. 00:22:25.200 --> 00:22:37.119 And I would also say we need to look at the categories of dressings as well and think about not just, you know, each individual dressing, but is it say a foam category that we need? 00:22:37.200 --> 00:22:41.440 And then what do we have that can that can actually be used in that space? 00:22:42.240 --> 00:22:52.559 Which then I guess leads me nicely into one of the most influential research programs, which was the Champions for Skin Integrity, which you were a part of, which began in aged care. 00:22:52.960 --> 00:22:56.240 It was subsequently expanded and adapted into other settings. 00:22:56.480 --> 00:22:59.119 This is a document that anyone can get their hands on. 00:22:59.279 --> 00:23:05.359 Can I say this document has featured in pretty much every presentation I've ever given? 00:23:05.519 --> 00:23:14.400 I advise all clinicians to look at it because what you guys did was second to none, and it really unpacks the dressings and the skin and what to do. 00:23:14.559 --> 00:23:16.319 It's really a go-to for clinicians. 00:23:16.480 --> 00:23:19.279 So let me ask a bit about the project. 00:23:19.359 --> 00:23:26.400 Uh, can you take us through how long it took and just maybe give us a little summary of um that that project and a bit more about it? 00:23:26.720 --> 00:23:31.200 Yeah, it was an exceptionally um exciting project to be part of. 00:23:31.279 --> 00:23:38.559 So I was a very junior researcher when this first started, and it's still going, and now I leave the updates of this project. 00:23:38.640 --> 00:23:39.680 So very exciting. 00:23:39.759 --> 00:24:00.319 And Professor Helen Edwards um led this work in the first instance where um she got a Australian government grant to be able to implement the Champions for Skin Integrity project across nine residential aged care facilities, but it was very much a multi-method study. 00:24:00.400 --> 00:24:04.240 So it wasn't just about going in and giving education. 00:24:04.400 --> 00:24:20.720 Um, some of the literature statistics talk about the fact that when we just deliver education, um, and I'm an academic and I lecture to my students, and you know, it says that they only take away about 10% of what we um talk to them about, which is terribly distressing sometimes. 00:24:21.039 --> 00:24:28.960 So this put scaffolding around that to go, okay, well, we're going to deliver this education, but we're also going to provide these resources. 00:24:29.119 --> 00:24:43.599 So we provided quite high-level guidelines that had the evidence associated with different wound types, but we also did um brochures for healthcare professionals, brochures for um consumers, people, their family, carers. 00:24:43.839 --> 00:24:52.559 Um, we did tip sheets that could go up beside people's bed and flow charts that could be put up in um treatment rooms so that people could go and look at them. 00:24:52.799 --> 00:25:00.240 And this was also combined with um teaching staff how to do audits, looking at has this made a difference? 00:25:00.400 --> 00:25:02.720 What worms are we actually looking at? 00:25:02.880 --> 00:25:03.759 What are we finding? 00:25:03.920 --> 00:25:07.200 What's our biggest issues within these facilities? 00:25:07.519 --> 00:25:19.599 Multidisciplinary environment involvement, so making sure that there was multidisciplinary teams that were supporting others within the residential aged care and peer support. 00:25:19.680 --> 00:25:24.880 So across these seven facilities that we started at, they each supported each other. 00:25:25.119 --> 00:25:40.880 And we've tried to really continue that in keeping residential aged care facilities, and we've now done this in primary care and in also rural regional settings, but trying to link people in together so they can support themselves when they have questions. 00:25:41.119 --> 00:25:45.359 And that was all tied up with a champion within

each facility as well. 00:25:45.599 --> 00:25:54.079 What we found really important was to have a second champion because staff change a lot within some facilities. 00:25:54.319 --> 00:26:05.519 So having that second person and also somebody that could be there to, you know, step in when somebody went on leave or just be able to talk through something with was really important. 00:26:07.039 --> 00:26:17.680 And so on that champion, um, what makes a good champion and really can appointing the wrong person or perhaps failing to support them actually achieve very little? 00:26:17.759 --> 00:26:19.279 What what what did you see? 00:26:19.759 --> 00:26:25.759 What we found was the best champion was the person that had a passion for wound care. 00:26:26.400 --> 00:26:30.799 So it wasn't necessarily the care manager, for example. 00:26:30.960 --> 00:26:41.599 It may be um an enrolled nurse that had a passion for wound care that could also communicate really well across the team as well. 00:26:42.079 --> 00:26:44.720 Um, and yeah, that was the most important. 00:26:45.279 --> 00:26:51.920 Yeah, you need those drivers in not only aged care, in hospitals, community, someone with a bit of passion. 00:26:52.000 --> 00:26:53.839 I I I couldn't agree more. 00:26:54.079 --> 00:27:00.319 Now, you've also done some significant work in the interprofessional wound care education space. 00:27:00.559 --> 00:27:09.920 Are we adequately preparing nurses, doctors, pharmacists, allied health professionals to assess and manage these wounds before they graduate? 00:27:10.480 --> 00:27:11.599 Not at all. 00:27:12.559 --> 00:27:24.480 Um, you know, there's very little, and you only need to look at the course outlines to know that there's very little wound care within healthcare professional courses. 00:27:24.720 --> 00:27:34.480 So, you know, finding a way of bringing disciplines together and learning about wound care, but also learning about each other's professions. 00:27:34.880 --> 00:27:42.160 Like you can't refer to a podiatrist when you get out in practice if you don't even know what a podiatrist does. 00:27:42.400 --> 00:27:49.119 And so I think there's that type of education and then learning together is so important as well. 00:27:49.359 --> 00:27:51.200 So we need to do better. 00:27:51.359 --> 00:28:06.799 And there are, you know, universities across Australia now, few of them, that are that do have um dedicated wound care units within their courses, but it's certainly not something that's mandated as part of accreditation. 00:28:07.039 --> 00:28:09.680 Um, and so and there's a lot to get through. 00:28:09.839 --> 00:28:20.960 You know, I understand that becoming a nurse or becoming a podiatrist, wound care is not all about what you do, but it's certainly a huge part of what we do, particularly in nursing. 00:28:21.200 --> 00:28:24.640 So I think uh we we absolutely need to do better. 00:28:24.960 --> 00:28:27.039 Yeah, I I totally agree. 00:28:27.200 --> 00:28:31.440 You know, I found um a couple of studies uh when I was looking at the research. 00:28:31.759 --> 00:28:44.640 And um, when you graduate, of course, it depends on what area and what field you go into, but most healthcare clinicians, according to these research papers I found, will spend more than 60% of their day dealing with wounds. 00:28:44.880 --> 00:28:48.160 So we absolutely need to move in this space a lot quicker. 00:28:48.240 --> 00:28:58.960 So if you could change one thing for undergraduates in terms of their education tomorrow, what fundamentals would you want to see across every university? 00:29:00.160 --> 00:29:08.400 Well, I'd love a dedicated wound care unit, but I suspect the cardiac nurse is going to say they want a dedicated wound care unit as well. 00:29:08.559 --> 00:29:22.720 So I think it's not necessarily, and sometimes I don't like the dedicated units because when you look at all the units that are studied, say across nursing, for example, wound care can fit into a lot of them. 00:29:22.960 --> 00:29:33.599 So if you're talking about cultural safety, if you're talking about health care across the lifespan, they're different units, but wound care would fit into all of them. 00:29:33.839 --> 00:29:38.160 So I think it's about scaffolding it in the different units. 00:29:38.319 --> 00:29:54.000 In in our first year, we teach a lot about um age care and we teach a lot about some some about um pressure injuries, for example, because they're going to see a lot of pressure injuries when they go out on their clinical placement. 00:29:54.400 --> 00:30:02.400 Um but we don't really expand on that to a lot of other wound types that um might be seen. 00:30:02.480 --> 00:30:16.160 So in our clinical units, in our theory of you know, um venous disease, arterial disease, how do we scaffold that within the units that we've got so that it's seen as something that is just normal business? 00:30:17.759 --> 00:30:18.880 Yeah, well said. 00:30:19.119 --> 00:30:25.200 And look, a lot of your research is also taking you into the world of those living with dementia. 00:30:25.359 --> 00:30:34.000 Um, you know, when we think about the statistics for wounds, we know that around 460,000 people will live with a wound at any one time in Australia. 00:30:34.240 --> 00:30:41.359 And interestingly, we hear a lot about dementia, and around 480,000 people will live with dementia. 00:30:41.599 --> 00:30:49.599 So not too far apart in terms of parallels, but now imagine somebody living with a wound who also has dementia. 00:30:49.759 --> 00:30:56.640 It can make it incredibly complicated and more complex to support that patient to heal their wounds. 00:30:56.799 --> 00:31:00.559 So, can you tell us a little bit about what you've been doing in this space? 00:31:00.960 --> 00:31:03.440 Yeah, it's a it's a really interesting space. 00:31:03.519 --> 00:31:14.400 And um, you know, we had done research for years where we had excluded people with

cognitive impairment and dementia for a number of different reasons. 00:31:14.559 --> 00:31:16.960 It's, you know, it's challenging. 00:31:17.200 --> 00:31:23.759 It's, you know, to get ethics approval um can be a little bit uh more high risk. 00:31:23.920 --> 00:31:31.920 Um, but it what that meant was there was nothing out there to guide practice for people with dementia who had a wound. 00:31:32.079 --> 00:31:38.640 In fact, when we did a literature review on it, the only wound that was mentioned was pressure injuries. 00:31:38.799 --> 00:31:43.519 And it was almost always about assessment and the prevention of it. 00:31:43.680 --> 00:31:45.920 There was very little about management. 00:31:46.160 --> 00:31:52.400 And yet, anecdotally, what what clinicians were telling me was um, why put a dressing on? 00:31:52.480 --> 00:31:53.759 They're just gonna rip it off. 00:31:54.160 --> 00:31:56.160 Why put an expensive dressing on? 00:31:56.240 --> 00:31:57.759 They're just gonna rip it off. 00:31:57.920 --> 00:32:01.839 And it's like, but that's not good evidence-based practice. 00:32:02.000 --> 00:32:04.079 So how do we fill that gap? 00:32:04.400 --> 00:32:08.480 So we did a little bit of work on looking at, well, what are the different wound types? 00:32:08.559 --> 00:32:17.920 And interestingly, the immobile patients with dementia, yes, their highest um wound types are pressure injuries. 00:32:18.160 --> 00:32:27.599 But when we're looking at the um early stage people with cognitive impairment, the wandering um that they have. 00:32:28.079 --> 00:32:44.240 You know, I've got a friend who works in DTA and she talked to me about her research that says that some of these people are walking 10,000 steps every single day, and and more than that, that's more than I do sometimes in four days. 00:32:44.480 --> 00:32:49.200 And so ill-fitting shoes, there was a lot of pressure injuries on feet. 00:32:49.440 --> 00:32:56.960 Um, there was also quite a lot of skin tears because they're doing so much walking and they're running into things and they're getting skin tears. 00:32:57.200 --> 00:33:06.799 So interestingly, though, the evidence is the evidence, and uh, probably works exceptionally well. 00:33:07.039 --> 00:33:12.400 What we found was it was the behavior management that we needed to deal with. 00:33:12.720 --> 00:33:28.960 And so this has landed with a DTA toolkit that's up on the Dementia Training Australia website and looks at complex care procedures that had never been looked at in that space before and takes wound care as an example of practice. 00:33:29.200 --> 00:33:32.559 And it's about how do we manage those behaviors. 00:33:32.799 --> 00:33:36.960 So if somebody's not ready to have their dressing done at 9 a.m. 00:33:37.200 --> 00:33:45.920 of a morning, then perhaps we consider whether we do it in the afternoon, whether we consider whether we do it when they've got a family member there. 00:33:46.079 --> 00:33:54.960 It's just changing our behaviors to be person-centered, really, at the end of the day, and to consider what that person needs. 00:33:55.119 --> 00:33:58.000 So still a lot more research to be done. 00:33:58.160 --> 00:34:05.680 Um, I know that iSTAP has come out with a document that looks at skin tears for people with dementia. 00:34:05.839 --> 00:34:08.800 Um, so and and it is a growing body of evidence. 00:34:08.880 --> 00:34:10.000 I think we will get there. 00:34:10.079 --> 00:34:11.119 It's so important. 00:34:11.840 --> 00:34:12.880 It's very important. 00:34:13.039 --> 00:34:17.519 It's really about, as you said, those unmet needs of the person living with dementia. 00:34:17.599 --> 00:34:18.800 How do we tackle that? 00:34:18.960 --> 00:34:28.719 Obviously, um, I've been working in the aged care space as well as all other areas of community and younger children, of course, but aged care predominantly for many, many years. 00:34:28.800 --> 00:34:33.280 And it's challenging because a lot of the older people will be also living with dementia. 00:34:33.440 --> 00:34:43.199 Um, some practical tips that we would often do uh at wound rescue is you know, dementia Australia talks about the colours are really important for someone living with dementia. 00:34:43.280 --> 00:34:53.360 So you won't put a white tablecloth down and then a white plate with their food on the table because they will have um finding issues of being able to find that area of the food. 00:34:53.599 --> 00:34:54.639 So I do the same. 00:34:54.800 --> 00:34:57.280 There are different color bandages that you can get. 00:34:57.440 --> 00:35:06.960 And I always say to aged care providers, get yourself a heap of those crate bandages in the different colours and what they're wearing for the day, put the same colour bandage on. 00:35:07.119 --> 00:35:16.719 And since I've been doing that practice, I find more, I won't use the word compliance, but I'm finding those living with dementia leave their dressings on for a lot longer than they would otherwise. 00:35:16.880 --> 00:35:19.679 So I don't know, that's one practical suggestion. 00:35:19.840 --> 00:35:23.840 Do you have any other practical suggestions that's come up from your research? 00:35:24.639 --> 00:35:33.760 Um, look, we did a co-design um workshop and talked to a lot of clinicians about what they were seeing and what their thoughts were. 00:35:33.920 --> 00:35:44.480 And that certainly came up about the colour and picking the colour, whether it matched the person's skin tone, whether it matched what they were wearing for the day. 00:35:44.639 --> 00:35:56.239 Um, other things come up about covering the dressing so that, you know, whether it was with a limb protector, whether it was with clothing, so that they wouldn't be able to see it. 00:35:56.320 --> 00:36:11.119 Um, there was an interesting suggestion of a fiddle dressing, like they have sort of fiddle blankets and fiddle aprons and that, um, whether that would stop them from removing it,

but all research still to be done. 00:36:11.360 --> 00:36:12.079 Haley. 00:36:13.280 --> 00:36:17.679 Plenty of years to go, I think, for you and I, Christina, in the world of research. 00:36:17.840 --> 00:36:23.199 So, look, some of your other work you're working on, geez, you're you're doing a lot, but some really great stuff. 00:36:23.280 --> 00:36:26.239 You've um developed some guidance for pharmacists. 00:36:26.400 --> 00:36:29.679 We know that their scope of practice changed a couple of years ago. 00:36:29.840 --> 00:36:39.920 And so pharmacists are often one of the first health professionals someone sees when they develop a wound that you know the customer walks in and says, I've got a wound, what dressing do I put on it? 00:36:40.079 --> 00:36:42.880 Um, but are pharmacists really equipped for wound care? 00:36:43.119 --> 00:36:44.559 They tell us no, they're not. 00:36:44.639 --> 00:36:45.920 That's coming from their mouths. 00:36:46.000 --> 00:36:48.559 We get called in a lot to support pharmacists. 00:36:48.800 --> 00:36:53.119 Uh are we underutilizing pharmacists to some degree in wound care? 00:36:53.360 --> 00:36:54.880 And how can we support them better? 00:36:54.960 --> 00:36:56.880 And what are you working on at the moment? 00:36:57.599 --> 00:37:05.039 So, yeah, there's um there was a consensus document that's been developed for pharmacists because you're quite right. 00:37:05.199 --> 00:37:10.239 Like a lot of people, the first person they will see is a pharmacist. 00:37:10.559 --> 00:37:29.199 And I think it it's tricky because people go to their GPs, they have a short period of time these days, and often they will go in and they will ask for things that they think are a priority, so their medications for their heart, their, you know, their need to do a follow-up x-ray on something. 00:37:29.440 --> 00:37:42.000 They won't think to tell them about the wound that's been on their leg for the last six weeks, because well, really, that's just a natural part of aging, really, um, which we know it's not, but that's what they think. 00:37:42.320 --> 00:37:54.639 But then more likely if they're standing there waiting for a pharmacist, perhaps, waiting for their medication, or the pharmacist, you know, asks them how they've been, and they say, Well, yeah, no, I've been good. 00:37:54.719 --> 00:37:57.679 This, you know, this wound on my legs, just a bit annoying. 00:37:57.840 --> 00:38:03.199 And there's that opportunity to bring it up, whereas they may not have had that opportunity before. 00:38:03.440 --> 00:38:18.559 I think also in our rural, regional, remote areas as well, you know, we're lacking clinicians in some of those areas, particularly GPs, um, you know, nurses we are calling out for in those areas. 00:38:18.719 --> 00:38:27.760 So if there's a pharmacist, then they are also another person that that you know a person can go to to be able to get that advice. 00:38:28.000 --> 00:38:34.639 I think that comes with education and training, and I think the pharmacists know that, and I think that's certainly going on at the moment. 00:38:34.800 --> 00:38:51.119 So some pharmacists are trained in being able to give that wound care, but I think it's really important that they understand the, you know, the assessment that then leads to the management and be able to actually incorporate that within their practice. 00:38:51.360 --> 00:38:54.880 Otherwise, it's about knowing who to refer on to as well. 00:38:55.119 --> 00:39:03.599 It's who is in that area that if they think that person needs to be referred to somebody, that they actually get in to be seen. 00:39:03.679 --> 00:39:10.079 Because we know that the quicker a wound is dealt with, the quicker it is going to heal. 00:39:10.639 --> 00:39:11.360 Absolutely. 00:39:11.519 --> 00:39:21.119 And look, in fairness to some of these pharmacists, when their scope of practice changed, they're already putting their hands up saying we don't have the environments to actually manage these wounds. 00:39:21.280 --> 00:39:22.400 So, rightly so. 00:39:22.559 --> 00:39:25.519 And look, to all the pharmacists listening in, we're here to help. 00:39:25.679 --> 00:39:28.320 We're all here to help, and we'll do the best we can to support you. 00:39:28.400 --> 00:39:31.679 But get in early with those referrals to Christina's point. 00:39:31.840 --> 00:39:36.320 So, Christina, I want to get into some of the more controversials. 00:39:36.480 --> 00:39:45.599 And you've had decades of evidence showing that compression, or we've had decades of evidence showing compression is fundamental to venous leg ulcer management. 00:39:45.760 --> 00:39:51.599 So I have to ask, why are patients still receiving months and months and months of dressings? 00:39:51.679 --> 00:39:56.880 We'll change it to this one, we'll change it to that one without adequate compression. 00:39:58.400 --> 00:39:59.039 Yeah. 00:39:59.440 --> 00:40:05.519 Um I think there is still a scare factor in compression. 00:40:05.760 --> 00:40:12.639 I think that, you know, there's this lack of confidence in being able to say, no, my assessment is good. 00:40:12.880 --> 00:40:20.800 And if if not assessment good, who are you going to refer to to make sure that you've got that assessment done properly? 00:40:20.960 --> 00:40:30.320 Like if you don't have the ability to do an ABPI or you don't have the confidence in doing it, who are you going to refer to to make sure that's that's done? 00:40:30.480 --> 00:40:36.079 It's not about just going, I don't have the confidence to do it, so I'm just not going to do it. 00:40:36.400 --> 00:40:40.880 We need to make sure that we actually, it's within our scope of practice as nurses. 00:40:41.199 --> 00:40:48.320 So we have a responsibility ourselves to make sure that we have that knowledge and education to be able to do it. 00:40:48.559 --> 00:40:53.039 And then we have the resources to be able to back that up. 00:40:53.360 --> 00:40:59.519 Um, it is,

you know, we also need to know that our patients can afford to pay for it as well. 00:40:59.920 --> 00:41:09.679 So it is a holistic coming together of all things that need to be able to put this into practice. 00:41:10.639 --> 00:41:18.719 Look, your your research also suggests we can identify relatively early when a venous leg ulcer isn't progressing as expected. 00:41:18.880 --> 00:41:30.320 You know, the patients that we see with these lower leg wounds, they've had them for years, 10 years, 15 years, 19 years, really long time to be living with a wound. 00:41:30.559 --> 00:41:41.360 So should we be more critical of wounds that are allowed to continue for months or even years without someone stopping and asking why they aren't healing? 00:41:41.679 --> 00:41:43.599 Oh, we have to be more critical. 00:41:43.760 --> 00:41:52.159 We have to, you know, we can't for our patients, we need to be saying, why is this wound not healing? 00:41:52.239 --> 00:41:54.239 And what can we do about that? 00:41:54.480 --> 00:41:58.079 And we also need to consider when we need to refer off. 00:41:58.239 --> 00:42:03.199 I think every nurse, every clinician has a role in wound care. 00:42:03.440 --> 00:42:11.840 Um, but when does it get to the point where we go, we need to refer this person to a specialist wound clinic? 00:42:12.000 --> 00:42:19.199 And I understand that sometimes that's tricky as well because sometimes there's waiting lists for these specialized wound clinics to get into. 00:42:19.599 --> 00:42:23.519 Um, but we need to think about this isn't working. 00:42:23.920 --> 00:42:26.000 What do we need to do to change it? 00:42:26.159 --> 00:42:28.320 We can't just keep doing same, same. 00:42:28.639 --> 00:42:29.360 Yeah, yeah. 00:42:29.519 --> 00:42:34.880 And look, we've we've touched on the lack of training in our universities. 00:42:35.119 --> 00:42:37.920 So here's a perky question that I have for you. 00:42:38.079 --> 00:42:46.960 Are universities graduating, you know, these healthcare professionals who simply don't know enough about wounds to practice safely enough? 00:42:48.079 --> 00:42:51.360 Look, I I think they have some of the basics. 00:42:51.840 --> 00:42:59.119 Um, I don't think they're learning about interdisciplinary care in wound care. 00:42:59.440 --> 00:43:04.239 Um, I don't think, and it's really difficult because this is such a complex, challenging space. 00:43:04.400 --> 00:43:06.719 We can't teach them everything. 00:43:07.119 --> 00:43:18.480 So, how is it that we're also supporting them when they're very new in practice to learn about the things that they haven't learned within university as well? 00:43:18.800 --> 00:43:23.840 Um, you know, there's so much that we're trying to pack into a three-year nursing degree. 00:43:24.000 --> 00:43:26.480 Um, so much more than wound care. 00:43:27.039 --> 00:43:36.320 So, you know, I think I would like to see nursing as a four-year degree, um, but that's a bit controversial. 00:43:36.559 --> 00:43:43.440 Um, you know, other other health professionals have four year degrees to try and get in what we need them to learn. 00:43:43.599 --> 00:43:48.719 So no, no, it's a it's a very fair point, and I have heard others say that as well. 00:43:48.880 --> 00:43:55.679 It it's it's a highly skilled profession, and maybe that's where we do need to move towards is that four year degree. 00:43:55.840 --> 00:43:59.599 I'd also say to all graduate nurses, find that comfortable. 00:44:00.239 --> 00:44:01.360 Person that mentor. 00:44:01.440 --> 00:44:04.159 We all have mentors, people that get to my age. 00:44:04.239 --> 00:44:05.280 We've all had mentors. 00:44:05.360 --> 00:44:10.480 I had a great mentor, but I'd also say to mentors, keep your skills up as well. 00:44:10.800 --> 00:44:16.239 Because you're going to have these graduates learning from you and soaking up all your good information. 00:44:16.480 --> 00:44:18.639 But please keep your skills up as well. 00:44:18.800 --> 00:44:23.679 Christina, you've made it through the core questions and done that so eloquently, I have to say. 00:44:23.840 --> 00:44:25.920 But I have one final question for you. 00:44:26.239 --> 00:44:36.000 If every clinician listening today remembered just one pearl of wisdom from you, from this conversation, what would you want that message to be? 00:44:37.039 --> 00:44:38.400 We can do better. 00:44:38.639 --> 00:44:40.159 We should do better. 00:44:40.480 --> 00:44:42.239 This requires education. 00:44:43.039 --> 00:44:48.719 It requires critical thinking and it requires thinking holistically and person-centered. 00:44:50.000 --> 00:44:51.119 Nicely said. 00:44:51.280 --> 00:44:54.559 I do, I'm very for AI and innovation. 00:44:54.639 --> 00:44:56.480 It's an interest area of mine. 00:44:56.800 --> 00:45:03.199 And the only thing that concerns me is that will we one day lose our critical thinking? 00:45:03.360 --> 00:45:04.320 That concerns me. 00:45:04.400 --> 00:45:05.599 That keeps me up at night. 00:45:05.760 --> 00:45:09.599 So to your point, Christina, you've heard it from one of the best today. 00:45:09.760 --> 00:45:12.800 Stay relevant, is what Christina is telling you all. 00:45:13.039 --> 00:45:15.039 A wound is never just a wound. 00:45:15.199 --> 00:45:22.000 It's the walk that never happened, the grandchild that couldn't chase, the confidence they slowly lost. 00:45:22.239 --> 00:45:24.960 At woundrescue, we see more than the wound. 00:45:25.119 --> 00:45:32.159 We bring advanced wound care directly to homes, aged care, general practice, and communities across Australia. 00:45:32.320 --> 00:45:35.039 Because we're healing lives, not just wounds. 00:45:35.280 --> 00:45:43.199 Call 1300-193-195 or visit woundrescue.com.au today. 00:45:43.599 --> 00:45:48.400 So, all right, Christina, we're going to finish with uh a segment called Rapid Fire. 00:45:48.480 --> 00:45:52.559 This is where we get to unwrap whether something is true or false.

00:45:52.800 --> 00:45:54.960 The bonus is there's no time to elaborate. 00:45:55.039 --> 00:45:58.800 You have to think quick and on your feet, and it's really about having a bit of fun. 00:45:59.039 --> 00:46:00.880 Are you willing to give it a go? 00:46:01.199 --> 00:46:02.320 Ready to go. 00:46:02.639 --> 00:46:03.280 All right. 00:46:03.760 --> 00:46:04.960 Let's kick it off. 00:46:05.199 --> 00:46:10.800 Clinical judgment alone is enough to predict whether a venous leg ulcer will heal. 00:46:11.119 --> 00:46:11.440 No. 00:46:12.320 --> 00:46:18.559 If a venous leg ulcer isn't progressing early, we should reconsider what we're doing. 00:46:18.880 --> 00:46:19.519 Yes. 00:46:20.159 --> 00:46:24.880 The dressing is the most important part of treating a venous leg ulcer. 00:46:25.199 --> 00:46:25.519 No. 00:46:26.400 --> 00:46:29.920 Social factors can influence whether a wound heals. 00:46:30.239 --> 00:46:30.880 Yes. 00:46:31.519 --> 00:46:35.840 Compression remains underused in venous leg ulcer management. 00:46:36.239 --> 00:46:36.800 Yes. 00:46:37.519 --> 00:46:42.639 Every healthcare graduate should leave university with basic wound assessment skills. 00:46:42.960 --> 00:46:43.599 Yes. 00:46:44.159 --> 00:46:48.159 Having a wound champion automatically improves wound care. 00:46:48.559 --> 00:46:48.880 No. 00:46:49.760 --> 00:46:53.679 Wound care is still too siloed between professions. 00:46:54.159 --> 00:46:54.800 Yes. 00:46:55.440 --> 00:47:00.320 And better education can generally change wound outcomes. 00:47:00.559 --> 00:47:01.199 Yes. 00:47:01.599 --> 00:47:04.239 Oh, Christina, you made it through so well. 00:47:04.480 --> 00:47:06.719 Thank you so much for joining us today. 00:47:06.800 --> 00:47:08.480 You've been absolutely brilliant. 00:47:08.639 --> 00:47:15.760 I think today's conversation has really highlighted that good wound care is about much more than what we put on the wound. 00:47:15.840 --> 00:47:17.840 It's about recognizing risk early. 00:47:17.920 --> 00:47:29.119 You've explained that so eloquently, understanding why a wound isn't progressing, treating the underlying cause, and looking at the whole person and not just the wound in front of them. 00:47:29.360 --> 00:47:31.920 Your research has taken it to the next level. 00:47:32.079 --> 00:47:34.880 I hope everyone can get a hold of your PhD. 00:47:34.960 --> 00:47:36.880 I've read it from start to finish. 00:47:36.960 --> 00:47:38.079 It was so interesting. 00:47:38.320 --> 00:47:46.400 So, Christina, thank you for sharing your research, your clinical experience, and your passion for improving wound care education. 00:47:46.559 --> 00:47:49.519 It's been an absolute pleasure having you on Woundcare Unwrapped. 00:47:49.840 --> 00:47:50.480 Thanks, Haley. 00:47:50.639 --> 00:47:52.480 It's been an absolute pleasure being with you. 00:47:52.719 --> 00:47:53.920 Love talking. 00:47:54.400 --> 00:47:58.320 Thank you for tuning in to this episode of Woundcare Unwrapped. 00:47:58.480 --> 00:48:05.760 You can find us on LinkedIn, Facebook, Instagram, and TikTok at woundrescue PTY LTD. 00:48:06.000 --> 00:48:08.800 A big thank you to our show partners at Learn on the Move. 00:48:08.960 --> 00:48:11.119 You can find more about them on the show notes. 00:48:11.440 --> 00:48:15.039 Woundcare changes when we start having better conversations. 00:48:15.280 --> 00:48:19.360 And that's why we believe it's about healing lives and not just wounds. 00:48:19.599 --> 00:48:23.519 Tune in for next week's episode of Wound Care Unwrapped.