SmartTRAK reviews the 2020 Virtual EWMA meeting covering the impact of COVID-19, the growing use of digital tools and emerging technologies
For the first time, the European Wound Management Association (EWMA) annual meeting, held November 18 – 19th 2020, was an all-virtual event. As the premier wound care conference in Europe, EWMA 2020 showcased the latest news and trends in the market for European Advanced Wound Dressings, which is projected to reach $1.8B in 2020 according to SmartTRAK estimates. It turned into a truly global event thanks to the format that welcomed 9,758 registered participants from 113 countries from all over the world.
In addition to the unique format of the meeting, SmartTRAK highlights key takeaways from EWMA 2020, including the impact of COVID-19 on wound care companies and products, the growing use of digital tools for wound care assessment and treatment and what’s next in terms of emerging technologies.
Key Takeaways from the Virtual Format
From a clinical perspective, the virtual format worked very well. The presentations were pre-recorded to ensure good quality, followed by a Q&A session. Posters could be reviewed without stress, since many times they are taken down before the live conference's end. Several posters had a presentation by the author available.
The exhibit hall still had a ways to go. The interaction was much more difficult; the platform needs to be developed to stimulate interaction and companies need to develop their digital tools and skills. It is a dramatic difference between showcasing a product live, allowing the clinician to feel the products and ask direct questions, compared to a YouTube video available online together with pictures of their product range. Digital readiness was demonstrated at various levels and SmartTRAK expects to witness further developments going forward, from both conference arrangers and companies.
There were 471 scientific presentations in five main streams which can be viewed on-demand in the virtual conference platform until the end of the year. In 2019, there were around 3,600 attendees. The number of participants nearly tripled this year as people could join in an effortless way and at a reasonable expense.
The format of the virtual platform did not stimulate interactions in a seamless way, a major difference compared to a live event. Companies were able to share highlighted products and information via a virtual exhibit hall and sponsored many industry symposiums. Companies did not launch new products at EWMA, likely because the timing is not right due to the pandemic and also because the virtual format makes it more difficult to showcase new products.
The pandemic has impacted the wound care market in different ways.
- All-in-one dressings with longer wear times and high absorption more widely used
- Family more involved in care
- Pressure injuries are impacting both patients and health care professionals
- Remote care stimulates use and development of digital tools
- Remote education exploding
- Wounds become worse and infected
Companies commented throughout the conference on the impact COVID-19 has on health care resources in wound care and shared their experiences of difficulties in providing wound care. In these special times where patient-clinician interactions should be limited, clinicians are using more dressings with long wear times. Mölnlycke* Health Care dedicated an industry symposium on this topic. During the symposium, Leanne Atkin PhD MHsc RGN, vascular nurse consultant, Huddersfield, UK noted how everything changed during the pandemic, as many patients were scared to seek care during the lockdown, even those with terrible diabetic foot infections. “I spent many hours begging patients to attend the outpatient appointment which they refused and at the end we had to do the consultations through windows. My favorite story was meeting a gentleman with ischemic leg ulceration through his bay window in the pouring rain as he saw me and the nursing team as a risk,” said Dr. Atkin.
Family involvement in treatment has also increased as the fear factor and more limited possibilities to visit healthcare facilities have significantly deteriorated patient options. Leanne Atkin also described how dressing choices were impacted in the pandemic. In her practice, dressings with high absorption are preferred and bordered foams were favored over non-bordered foam since patients can apply those better themselves and put the compression sock over it.
Remote wound care is becoming highly acceptable and can bridge the physical distance between patients and care providers. Santamaria et. al.’s 2013 study showed that although there are technologies available, they are not integrated with current hospital medical records. The current situation highlighted that the healthcare sector has not taken major improvement steps forward. The patient with a wound is engaging services across hospital and community settings and integrated systems are needed to carry this out in an efficient way. Stakeholders need to develop improved care pathways and ensure patient information is protected.
One aspect of the pandemic is that patient education has gained attention and is a clear focus for both companies as well as health care service providers. The development of digital education is exploding.
When it comes to pressure ulcers, COVID-19 has a double impact. As showcased by Professor Amit Gefen pressure ulcers are more likely to develop and progress faster from a physiological perspective if patients are infected by COVID-19. In serious cases, patients in intensive care units are more likely to develop medical device-related ulcers and to be placed in the prone position to improve tissue oxygenation, which can lead to a higher risk of tissue pressure injuries.
Not only for patients but also for healthcare professionals, the pandemic has brought more exposure to extended wear time of masks and PPEs, leading to more medical device-related pressure injuries. The Skin Health Group from the University of Southampton showcased bioengineering approaches to define the risk of soft tissue damage from face masks. Researchers found the average advised daily time spent in PPE is less than 10 hours and advised healthcare providers to increase the frequency of breaks from wearing PPE. The paper “PPE related skin reactions in healthcare professionals during COVID19” by Abiakam et al., submitted for publication, addresses the specific design of masks and the connection related to pressure injuries in different sites.
Smith+Nephew* presented the results of a survey from EWMA (N=217) on wound management during and after COVID-19. Most respondents were wound care nurses and doctors, 32.5% worked in an acute care setting and 15.3% in wound care clinics. Almost half (46.1%) said that they still managed their patients face-to-face during the spring lockdown (most probably those who work in acute care setting) and 31.5% said that they used the combination of face-to-face and remote consultation.
Nearly half of the respondents were confident that their patients could apply the dressing by themselves. Respondents were pessimistic about the future, where 43.8% thinks that wounds will have become more chronic, 35.5% expects more wound infections and 31.3% anticipate more chronic wound complications. There were many positive suggestions on how the industry can help in these critical times, e.g., dressings with clear instructions, patient support materials and offering remote educations.
New Digital Technologies in Service for the Future
Challenges of living with wounds and the changing health care environment provide an even greater need for new technologies, but there are both pros and cons. For example, using a smartphone and imaging for wound assessment is excellent, as physical contact is not necessary. However, there are limitations to what a smartphone can do. You need to evaluate the size and depth of the wound, as well as the smell and color, and a smartphone can only partly support those evaluations.
An emerging concept is smart wound dressings with flexible electronics in which the dressing can provide and deliver continuous information about the wound without removing the dressing. (For example: Stretchable pH sensor by Rahim Rahimi et al, and Smart Bandage for Wireless Chronic Wound Monitoring by Muhammad Fahad Farooqui). While this is an exciting area, several challenges need to be overcome to make this a clinical reality. Efficient interfaces are needed for information transfer, they need to be scalable at a low cost, and health economics need to be clearly shown.
One example of a company presenting a smart app was Imito AG, a Swiss-based company. They showcased an app that helps the clinician take photos in a correct and consistent way and document information like wound shape, size, image and wound bed-related information.
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