Home' Australian Ageing Agenda : AAA Jul-Aug 2012 Contents References:
1. DiMatteo MR. Formulary 1995; 30: 596--8, 601--2, 605.
2. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral
anticoagulation: a systematic review and meta-analysis. Lancet 2006;367:404-411.
3. Ansell J et al. Int J Cardiol 2005; 99: 37--45.
4. Butchart EG et al. J Thorac Cardiovasc Surg 2002; 123: 715-23.
Roche Diagnostics Australia Pty Limited., 31 Victoria Ave Castle Hill NSW 2154,
Phone: 02 9860 2222 ABN 29 003 001 205
COAGUCHEK, BECAUSE IT'S MY LIFE are trademarks of Roche.
The importance of compliance
• Compliance rate with long-term medication in general has been estimated at between 50% and 60%1
• Evidence shows that INR monitoring improves the quality of oral anticoagulation between 50% and 85%2
The obvious choice is partnering VKA and
CoaguChek® XS Plus for improved compliance
* Aged Care Standards and Accreditation Agency Ltd, Accreditation Standard 2, 2.7 Medication management.
Compliance and monitoring - inter-related
factors in oral anticoagulation
...two essential components for optimising
oral anticoagulation therapy enables quality of care.*
Warfarin -- a particular case in point
• This is increasingly prescribed as lifelong therapy for patients with mechanical heart valves, atrial
fbrillation or thrombophilic disorders, effectively preventing arterial embolism in a wide range of
• Maintaining INR within its therapeutic range is effectively achieved through monitoring
• Patients on warfarin who have had a heart valve replacement there was a 32% difference in survival
15 years between patients with low and high variability in anticoagulation control4
k XS Plus
Community Outreach Service at the Queensland University of
Although the service she runs caters primarily to people in
Brisbane and surrounding areas, Gibb regularly gives advice
to aged care staff from around Queensland and northern NSW,
which often involves looking at emailed photographs.
"At the moment it's not done formally; it's all completely
informal and literally just because we want to help," she says.
"But if it got to the point where it became something that we
really needed to build into our business model, then that's
something that we could easily do."
Some of those callers are from nursing homes where the
service has run outreach clinics, although Gibb says she found
that clinicians really want targeted support with tricky wounds
on hand when they need it.
She believes that specialised wound care software -- like that
used by LCHS, or Western Australia's impressive state-wide
advisory and education service, Wounds West -- is "definitely the
way of the future" for services like hers, and is very interested in
being involved in such a system.
Gibb is certainly not alone in describing electronic wound
management as 'the way of the future', but the technology
itself has a history in Australia going back to the late nineties,
when Professor Nick Santamaria and Associate Professor Lexie
Clayton developed the Advanced Medical Wound Imaging System
(AMWIS) at the University of Melbourne.
Professor Santamaria then moved to WA and led development
of the world-leading Wounds West system, while the AMWIS
earned its stripes in clinical trials and went on to be used widely
in Australia, including in aged care as a component of Leecare
Solutions' clinical software.
All of Australia's aged care software vendors now include
wound care modules in their clinical systems and increasingly,
staff are using mobile devices to assess and photograph wounds
at the point of care.
The exact specifications may vary but through these modules,
clinical software is providing the benefits of electronic wound
management, as described by Marianne Cullen, to a large section
of the aged care industry.
Accurate data is allowing them to improve their processes
over time, and shared access to client records -- with wound care
progress notes and photographs -- is enabling aged care staff to
work together across multiple sites to provide better care, just as
it is in Gippsland and all over Western Australia.
ALL IN THE IMAGES
As a research fellow from RDNS Victoria's research institute,
Suzanne Kapp has been involved in evaluating various wound
care technologies, mainly their imaging and measurement
Software like AMWIS, for example, accurately measures
and tracks different parts of the wound's surface area, using a
calibration measure on the skin.
Another system the RDNS Institute has evaluated -- the
Silhouette, made by ARANZ Medical -- does the same thing without
any contact, using a system of lasers, but may struggle to compete
on price with regular digital cameras or mobile devices.
In Kapp's experience, basic digital cameras can definitely
be used effectively for wound care; it just comes down to
So it probably pays to make sure staff are across basic
techniques like having the light source behind or to the side of
the camera, and simple settings like choosing the right 'white
balance' for more accurate colour reproduction in different kinds
of light -- such as fluorescent, tungsten or sunlight.
"We find that a fairly basic digital camera can take a
reasonable image," Kapp says. "It's a bit of a trick sometimes to
get a good image, but it's usually related to the environment --
the lighting and the positioning of the client -- more so than the
camera. Some of the phones today take amazing photos." n
AAA | JULY -- AUGUST 2012 | 43
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