The editorial team of Advances in Skin & Wound Care extends a heartfelt thank you to our readers, advertisers, and publisher for enabling the journal to reach a significant milestone this year: its 20th anniversary! Your support for the journal (formerly Decubitus, then Advances in Wound Care) is an enduring tribute to its founding editor, Dr Roberta S. Abruzzese, and those who followed her, including the former editors, JoAnn Maklebust and Dr David Margolis.

In the past 2 decades, the journal has grown and developed from 4 issues a year in 1988 to the newly expanded frequency of 12 monthly issues. Along the way, we have listened to what you wanted in the journal and then shaped it to fit your needs. Our unique mix of original research and practical clinical articles is a direct result of your desire for cutting-edge information you can use in your practice every day. So is our InfoLink section, which reflects your request to be kept up-to-date on new products, educational opportunities, and more. And our recent decision to expand the journal's frequency is a response to the results of our reader survey, in which you told us how much you value the journal. We take your comments to heart, and we do all we can to give you more of what you want.

The occasion of the journal's 20th anniversary has given us the opportunity to reflect on our origins and the visionary people who brought us here, look at where we are now, and predict where we think skin and wound care is going in the future.

The Past

It is a rare person who can command the resources to bring a product or a vision full circle. Our founding editor, Dr Abruzzese, was that type of leader. Roberta, as she liked to be called, was a woman of clarity and strength who ignited some controversy among wound care practitioners when she named the new journal Decubitus. She loved words and always said, "When in doubt, use classical Latin." Roberta, in her wisdom, made sure the tagline underneath the journal's title clearly reflected what she wanted the journal to be: a compendium of prevention and treatment of pressure ulcers. Over the years, in response to changes in practice, the journal has expanded to include all wound and skin care issues.

In her first editorial, which we have republished in this issue, Roberta revealed her plan. Decubitus was to be "THE RESOURCE for all healthcare professionals interested in the prevention and treatment of pressure ulcers."1 Roberta's goal was to provide a comprehensive "one-stop shopping" resource for busy professionals.

When the journal was launched in the late 1980s, the concept of health care professionals working together as a team was emerging, and it was based on the premise that pressure ulcer care does not belong to any one group of health care professionals1 and that we needed to work collectively on solving this complex and devastating condition. In that vein, our first issue contained the announcement of a distinguished multidisciplinary team of experts who had formed the National Pressure Ulcer Advisory Panel (NPUAP).2 We celebrate the 20th anniversary of the NPUAP in this issue with a reflective article from members of that organization.3 The NPUAP's leadership over the past 2 decades has helped clarify contemporary pressure ulcer treatment and has exemplified the strength of multidisciplinary care.

The Present

A few years after the publication of the premier issue of the journal, the Agency for Healthcare Research and Quality (at the time called the Agency for Health Care Policy and Research) produced the first set of guidelines to define the clinical practice of pressure ulcer prevention (1992)4and treatment (1994).5 More recently, in 2004, the Wound, Ostomy & Continence Nurses Society updated the pressure ulcer guidelines to reflect the newest research in the area.6

Roberta believed that "success in pressure ulcer care required standards of reporting, more sophisticated prevention strategies, and publicized scientific bases for treatment."1 Today, there are many guidelines, not just for pressure ulcers, but also for other wounds, such as diabetic, venous, and arterial ulcers. Among these guidelines are the Wound Ostomy and Continence Nurses Society's series of guidelines,6-9 Canada's Best Practice Recommendations for the Prevention and Treatment of Pressure Ulcers: Update 2006,10 the Registered Nurses' Association of Ontario's Risk Assessment and Prevention of Pressure Ulcers Guideline,11 the European Pressure Ulcer Advisory Panel's Pressure Ulcer Guidelines,12 guidelines from the International Working Group on the Diabetic Foot,13 and the Singapore Ministry of Health's Nursing Management of Pressure Ulcers in Adults.14 The challenge to clinicians is now 2-fold:

* What is the equality of and what are the gaps in those guidelines?

* How can we translate the guidelines into sustained clinical practice?

Collective national and international cooperation to achieve the common goal of restoring patients' functioning and enhancing our knowledge as skin and wound care professionals will be crucial in the 21st century. What we can learn from each other globally and adapt to our circumstances locally will be key to advancing the practice of wound care on a broader scale.

Advances in Skin & Wound Care is at the forefront of the effort to link clinicians from around the world in a knowledge exchange. We are doing this through our partnership with the World Union of Wound Healing Societies, publication of original research from outside the United States, and the launch of our new World Union Reports department. We have even changed our tagline to The International Journal for Prevention and Healing to reflect this effort. The NPUAP has also done its part to raise awareness of the problem of pressure ulcers internationally by serving as a model for the European Pressure Ulcer Advisory Panel EPUAP and other groups around the world that have formed similar societies.

As we have reported in this journal over the past few years,15-17 the NPUAP has taken on the challenge of defining the ubiquitous purplish wounds that we often see in our patients-particularly our surgical patients. These wounds have been termed deep tissue injury (DTI) by the NPUAP, and this month, the group will share additional clinical insights and evidence about DTI at its national conference.

This is not a new concept to the journal. In the very first issue, Thomas P. Stewart, PhD, and Sandra J. Magnano, RN, raised questions about these wounds in their article, "Burns or Pressure Ulcers in the Surgical Patient?"18 Because this is such a timely topic for us as skin and wound care professionals practicing today, we have republished the article in this issue of the journal. We look forward to reporting more about the current thinking on DTI after the NPUAP conference.

Other topics addressed in the first issue of the journal are also still relevant today. For example, we continue to explore the extent that shear effects contribute to pressure ulcer development. In the first issue, Bennett and Lee19 had the courage to challenge the concept that 32 mm Hg is the threshold for capillary closing pressure. They wrote, "There is reason to question both the rationale and the experimental procedure leading to the 32 mm Hg threshold."19 Currently, the NPUAP and EPUAP are working together on a shear initiative to give us more insights into this area.

Defining-and then reducing-the prevalence and incidence of pressure ulcers has been an issue for many years. It has been difficult to get a handle on this problem because the true numbers are not known. A 2001 report from the NPUAP20 indicated wide ranges in incidence and prevalence numbers across health care settings, largely due to inconsistent study methodology. According to the latest national data from the Healthcare Cost & Utilization Project (HCUP), pressure ulcers in hospitalized patients increased by 63% from 1993 to 2003; however, the total number of hospitalizations increased by only 11%.21,22 Clearly, we need to work together on 2 fronts: first, to understand the magnitude of the pressure ulcer problem, and second, to decrease the numbers and patient suffering.

The cost of wound care is a great concern in today's health care environment, just as it was 20 years ago. It has been estimated that healing a single pressure ulcer costs between $15,000 and $27,000.23,24 The HCUP now reports that the average charge for pressure ulcer care based on principal diagnosis is $37,800.21

One way we might reduce costs is to find the most appropriate way to care for the local wound bed and stimulate healing. Decision making is a challenge because of the large number of therapies available to the wound care clinician. Since the October 2006 issue, we have taken a very detailed look at the individual elements and clinical ramifications of the concept of wound bed preparation.25-28 This paradigm may be our best hope for standardizing care and reducing costs. More research in the future will tell us if we are going in the right direction.

The Future

What will the future bring? Twenty years after the journal's launch, clinicians in our specialty are still struggling to find the quickest, least painful, and most cost-effective way to treat pressure ulcers and other wounds. New understanding of the biologic and cellular basis of wound healing, coupled with the development of new products, is changing the course of practice. New technology holds the promise for early detection-even prevention-of some wounds, such as pressure ulcers. We have moved from saline wet-to-dry dressings to moist interactive dressings. The future will feature active treatments with smart matrices, donor cells, and matrix materials designed for the stage and biologic deficiencies in a chronic wound. This will require new diagnostic techniques and a toolkit of active biologic therapeutic modalities that are designed for every need.

We also need to link education and care to patient outcomes, empower our patients to be their own advocates, and make evidence summaries of therapeutic alternatives. The knowledge base for evidence-informed practice should be available to all, and it should combine expert opinion, patient preference, and the evidence base in the literature.

Become Our Partner

As we look back over the past 20 years, we see that Advances in Skin & Wound Care has fulfilled Roberta's dream to be "THE RESOURCE" for clinicians. Join us as we continue on the path she charted for us in 1988. Let us know your thoughts on how we can make the journal even more relevant to your practice. Consider submitting your investigational research, reports of clinical experience, or letter to the editor (http://lwwesubmissions.edmgr.com). Or, contribute a poster to the 2007 Clinical Symposium on Advances in Skin & Wound Care (http://www.symposiumonwoundcare.com).

No matter how you do it, contribute to the process and become our active partner. Feel free to e-mail your ideas to Senior Editor Kathleen Greer at [email protected].

Respice, adspice, prospice- look to the past, the present, and the future.

Yours in prevention and healing,

-Richard "Sal" Salcido, MD

Editor-in-Chief

-Elizabeth A. Ayello, PhD, RN, APRN, BC, CWOCN, FAPWCA, FAAN

Clinical Associate Editor

-R. Gary Sibbald, BSc, MD, FRCPC (Med) (Derm), FAPWCA, Med

Clinical Associate Editor

-Cathy Thomas Hess, BSN, RN, CWOCN

Clinical Consultant

References