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Aim The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the 'Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline' (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. Methods A guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve individual patient outcomes using an international formal consensus process. Discussion Major methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. Conclusion The 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (http://www.internationalguideline.com/).

Background: Relational aspects of primary care are important, but we have no standard measure for assessment. The ‘working alliance’ incorporates elements of the therapeutic relationship, shared decision-making, goal setting and communication skills. The Working Alliance Inventory (short form) (WAI-SF) has been used in adult psychology, and a high score on the survey is associated with improved outcomes for clients.

Preventing wounds is a fundamental goal for all wound professionals and is enshrined within the Australian national wound management standards. The paper presents an overview of the recent evidence in the prevention of venous leg ulcers, pressure injuries, diabetes-related foot ulcers and skin tears. Recent literature searches identified a paucity of high-quality evidence for most wound prevention interventions. The paper presents evidence available to support current best practice. Despite the lack of strong scientific evidence, fundamental care interventions, including promoting healthy skin integrity and off-loading pressure, continue to be mainstay in preventing wounds of all aetiology.

It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting.1 Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age2 in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years.3 Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%.4-6 Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in poli

The International Wound Infection Institute (IWII) is a volunteer group of interdisciplinary health professionals dedicated to advancing and improving practice relating to the prevention and control of wound infection. The second edition of Wound infection in clinical practice is an update of the first edition published in 2008 and was endorsed by the World Union of Wound Healing Societies (WUWHS). The original document was authored by leading experts who were in wound management, many of whom formed the inaugural committee of the IWII. For the second edition, the IWII collaborative team undertook a comprehensive review of contemporary literature, including systematic reviews and meta-analyses when available. In addition, the team conducted a formal Delphi process to reach consensus on wound infection issues for which scientific research was minimal or lacking. This rigorous process provided a document with an update on the science and expert opinion regarding prevention, diagnosis and control of wound infection. The updated document outlines new definitions relevant to wound infection, presents new paradigms and advances in the management and diagnosis of a wound infection, and highlights controversial areas of discussion. The intent is to provide a practical, updated resource that is easy to use and understand.

Botanical and other natural products have been used for centuries for medicinal purposes including treating skin lesions and wounds. However, formal research into the efficacy of many traditional remedies is sparse. The Wound Healing and Management (WHAM) Node within the Joanna Briggs Institute (JBI) and Wounds Australia conducts evidence summaries on traditional wound care strategies as a resource for local wound care practitioners and staff and students on exchange programs in developing countries. This paper presents an overview on a number of botanicals used in wound care in countries with limited access to contemporary wound care products. The available evidence on effectiveness and potential adverse events for tea tree oil, turmeric, banana leaves, aloe vera, papaya and calendula used in wound care is presented. There is a need for further good quality research into many of the interventions presented in this review in order to increase the evidence base and understanding of any risks in incorporating natural resources into wound care.

It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%.Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence.The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice.These systematic judgments can assist in policy develo

Background: The role of family doctors in the management of obesity in primary care will become increasingly important as more of the adult population become overweight or obese. Having a solid understanding of the family doctor’s role as a sole practitioner is important for supporting practitioners in providing patient care and for informing future research. Objective: The purpose of this paper is to describe a protocol for a scoping review that aims to examine and map the current research base for the role of the family doctor in managing adults who are overweight or obese. Methods: This scoping review is based on the methodology as described by the Joanna Briggs Institute which involves final consultation with stakeholders. Two reviewers (ES, NE) will be responsible for the iterative development of a search strategy based on the basic initial search terms obesity, doctor and primary care. Black and grey literature will be searched to elucidate any manuscripts involving the family doctor in the management of adults who are over‑ weight or obese. A customised data extraction tool will be used to collect relevant items from each manuscript. Results: Data extraction will expose the role family doctors are playing in obesity management in all stages of research including recruitment, intervention or as a control group. By looking at a broad scope of manuscripts we will discover the family doctor’s role as portrayed in research, in international guidelines and by peak bodies. We will also determine if there are any gaps in the research base. Conclusion: This protocol describes a scoping review that will illustrate the supporting international research for the role family doctors are playing in the management of adults who are overweight or obese. Scoping of the interna‑ tional literature will then be translated for Australian primary care. Keywords: Obesity, Overweight, Adults, Primary care, General practitioner, Family doctor, Primary care physician

BACKGROUND Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. METHODS A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. RESULTS 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners' perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed "GP consultant teacher"). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. CONCLUSIONS Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning cu