Month: February 2018

Roles of alternative activation of macrophages phenotypes in normal wound healing

Normal wound healing process is characterized by highly organized controlled overlapping phases including haemostasis, inflammation, proliferation, and remodeling; through which acute wounds come to a complete healing with predictable time frame (Schreml et al, 2010). These phases are orchestrated by the interaction of different cell types and biochemical components to regulate and accomplish the different wound healing process such as coagulation, chemotaxis, phagocytosis, synthesis of extracellular matrix components, angiogenesis, epithelial migration, and remodeling components (Velnar et al, 2009). Components of the main cellular wound healing process include macrophages, keratinocytes, endothelial cells, fibroblast, neutrophils, and lymphocytes. These components are recruited, stimulated and activated according to their role in the healing process by which specific generic cytokines, growth factors, chemokines, and respective receptors are created to achieve physiological wound healing of skin wounds (Schreml et al, 2010).

read more (free account required)

Study to Explore the Impact of Simulating Extreme Obesity on Health Care Professionals ….

Extremely obese patients pose significant challenges for those who strive to provide care. The prevalence and consequences of weight bias and stigma in health care have been well documented, but research on how to reduce weight bias and stigma is limited. To assess the impact of simulating obesity on the attitudes and perceptions of health professionals toward extreme obesity, a qualitative study involving 6 registered nurses and 1 registered physiotherapist was conducted between November 2015 and May 2016.

 

Health professionals who had regular contact with persons with obesity were recruited through poster advertisement in 1 hospital and 2 universities. Participants completed a demographic survey that included their physical measurements (height, weight, and waist circumference). They then wore a suit simulating the shape and size of a person with extreme obesity for approximately 2 hours and engaged in activities such as taking public transport or visiting a café. Audiotaped, semistructured interviews were conducted before and after the suit exercise and transcribed verbatim for conventional content analysis that identified 3 main categories: 1) insights into the physical challenges facing people with extreme obesity; 2) awareness of social consequences for people with extreme obesity; and 3) changes in participants’ attitudes toward people with extreme obesity. Following the exercise, personal attitudes were found to be less judgmental and more empathetic. Using a simulation suit may increase awareness among health professionals regarding issues facing persons with obesity and may be a positive influence on diffusing weight stigma and bias in health care settings, particularly in the area of wound prevention … read more

Can Lactic Acid Bacteria Speed Wound Healing?

David G. Armstrong DPM MD PhD

Researchers are showing faster wound healing following the administration of lactic acid bacteria into wounds.

 

The study, published online in the Proceedings of the National Academy of Sciences of the United States of America, used a mice model to show wound healing.1 Researchers transformed Lactobacilli with a plasmid encoding C-X-C motif chemokine 12 (CXCL12), noting this enhanced wound closure via proliferation of dermal cells and macrophages, also leading to higher transforming growth factor-beta (TGF-β) expression in macrophages. The study notes that bacteria-produced lactic acid reduced the local pH, which inhibited the peptidase CD26 and facilitated a higher availability of bioactive CXCL12.

 

The authors also note that Lactobacilli delivering CXCL12 improved wound closure in mice with hyperglycemia or peripheral ischemia, conditions associated with chronic wounds.1 The study adds that the treatment showed macrophage proliferation on human skin in an in vitro model of wound epithelialization … read more

Thoughts on Cross Contamination in Wound Care

by Michel H.E. Hermans, MD

A recent article in Mayo Clinic’s Proceedings1 studies contamination of stethoscopes. After a standardized physical examination, several parts of the physicians’ hand were cultured and the results were compared to cultures of the stethoscope diaphragm and tube. As it turned out, fingertip contamination was highest but the diaphragm of the stethoscope showed a higher level than the thenar eminence of the physician’s hand. The conclusion of the article stated that the stethoscope may play a serious role in cross contaminating patients.

 

The study was executed well and the conclusion valid, which thus raises the question: what do we do about it? Wipe the entire stethoscope (the tubes were contaminated as well), use a diaphragm cover or a separate stethoscope for each patient?

 

This type of study is not new. The authors themselves quoted a series of similar articles, with one going back to 1972.2 Other studies have shown similar threats from neckties3,4 and white coats. Guidelines on how to minimize the chance of cross contamination are abundant and have been around for a long time. Most hospitals have their own guidelines, many of them based on those issued by the World Health Organization … read more

Electrical Stimulation for Pressure Injuries: A Health Technology Assessment

Background

Pressure injuries (bedsores) are common and reduce quality of life. They are also costly and difficult to treat. This health technology assessment evaluates the effectiveness, cost-effectiveness, budget impact, and lived experience of adding electrical stimulation to standard wound care for pressure injuries.

Methods

We conducted a systematic search for studies published to December 7, 2016, limited to randomized and non–randomized controlled trials examining the effectiveness of electrical stimulation plus standard wound care versus standard wound care alone for patients with pressure injuries. We assessed the quality of evidence through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). In addition, we conducted an economic literature review and a budget impact analysis to assess the cost-effectiveness and affordability of electrical stimulation for treatment of pressure ulcers in Ontario. Given uncertainties in clinical evidence and resource use, we did not conduct a primary economic evaluation. Finally, we conducted qualitative interviews with patients and caregivers about their experiences with pressure injuries, currently available treatments, and (if applicable) electrical stimulation.

Results

Nine randomized controlled trials and two non–randomized controlled trials were found from the systematic search. There was no significant difference in complete pressure injury healing between adjunct electrical stimulation and standard wound care. There was a significant difference in wound surface area reduction favouring electrical stimulation compared with standard wound care.

The only study on cost-effectiveness of electrical stimulation was partially applicable to the patient population of interest. Therefore, the cost-effectiveness of electrical stimulation cannot be determined. We estimate that the cost of publicly funding electrical stimulation for pressure injuries would be $0.77 to $3.85 million yearly for the next 5 years.

Patients and caregivers reported that pressure injuries were burdensome and reduced their quality of life. Patients and caregivers also noted that electrical stimulation seemed to reduce the time it took the wounds to heal … read more

Peripheral arterial disease and the diabetic foot

In peripheral arterial disease (PAD), atherosclerotic vessels in the periphery impair blood and oxygen perfusion to the lower limbs and may lead to increased risk of ulceration, wounds and amputations. PAD is also associated with increased risk of coronary and cerebrovascular incidents (Meru et al, 2006).

 

The main risk factors for PAD include smoking, diabetes, high cholesterol and family history (Meru et al, 2006). More than 50% of people living with PAD may not show any clinical symptoms, hence proper diagnosis and management is challenging (Hirsch et al, 2007; Norgren et al, 2007). This article will discuss the aetiology, presentation, risk factors, and management of PAD as related to the lower extremities.

 

Aetiology and presentation
PAD is a macrovascular complication of diabetes mainly caused by atherosclerosis, whereby fatty plaque deposits progressively narrow the lumen of the arteries and decrease vascular perfusion to the lower limbs … read more

The very first episode …

In October 2017 Craig found himself in England for 2 days whilst on the way back home from conferences in Spain and Portugal. Whilst there he dropped in at Ian’s house and whilst chatting after dinner they realised neither of them had ever recorded a Facebook Live so decided to give it a go. It was met with surprisingly positive feedback so they began wondering if there was some mileage in doing it more regularly. And thus, PodChatLive was born.

Combating Biofilms In The Chronic Wound

Given the complexity of biofilm in lower extremity wounds, these authors offer a closer look on how biofilm develops, keys to eradicating biofilm and emerging modalities that may have an impact in the future.

 

We all encounter biofilms on a regular basis in our practices. A biofilm is a complex polymicrobal community of bacteria and fungi that develops on foreign materials, necrotic debris, exposed bone, and within the bed of chronic wounds. When James and colleagues examined the biopsies of 50 chronic wound beds, 60 percent contained a biofilm.

 

Planktonic or free-floating bacteria are more aggressive and divide more rapidly. Changes in gene expression allow them to secrete hydrolase enzymes and exotoxins, resulting in more rapid local tissue invasion. As a bacterial colony develops, environmental stimuli induce the cells to engage in quorum sensing, a gradient-based recruitment strategy used to summon additional bacteria to the developing biofilm and alter the phenotypic expression of bacteria within the community. Free-floating planktonic bacteria adhere to the wound bed using very weak molecular interactions … read more

Wound Temperature and Healing

You’ve probably heard that it’s important to keep wounds moist and warm, But what’s the optimal temperature for healing a wound, and how do you maintain it? Read on for details.

 

When moisture evaporates from a surface, the surface cools. Sweat operates by this principle. So, unfortunately, do wounds. Whenever a wound loses moisture, the tissues of the wound drop in temperature.

 

The cells and enzymes of the body function best at normal temperature, around 37° C (98.6° F).  When wound temperature decreases by as little as 2° C, healing can slow or even cease. In short, when the temperature drops, the healing stops.

 

Furthermore, cooled tissues cause vasoconstriction and increase hemoglobin’s need for oxygen. As a result, there’s less oxygen available for the type of white blood cells called neutrophils to fight any potential infection.

 

Here’s the kicker: once the wound tissues cool– such as when left open to air during a dressing change– the wound base can take up to 4 hours to return to normal healing temperature. If a clinician changes a dressing TID, the wound may be outside of the optimal healing range 50% of the time … read more

 

FIVE NEW REGULATIONS TO WATCH FOR IN 2018: CMS REIMBURSEMENT

As the end-of-year countdown begins, we’re looking at changes that will impact the wound care industry in 2018. For the next several weeks, we’ll be running a series of insightful blog posts from our team of experts. Our first is from Rylan Smith, CFO.

 

Fall brings vibrant colors, homemade chili, championship baseball – and new CMS regulations for reimbursement! In reviewing upcoming changes for 2018, here are five takeaways that wound centers need to be aware of:

 

Supervision of hospital therapy services for critical access hospitals and small rural hospitals will reinstate the non-enforcement of supervision requirements. In the 2018 OPPS proposed rule, CMS revisits the moratorium on enforcement of the direct supervision rule for critical access hospitals and small rural hospitals with less than 100 beds. This is a positive development for these hospitals, because physician time is at a premium. The implication for hyperbarics is that it provides for some flexibility with direct supervision. We at Wound Care Advantage always recommend having a physician immediately available when a patient is in the chamber. This rule will extend the moratorium through 2019 … read more

A review of the scientific evidence for biofilms in wounds

Both chronic and acute dermal wounds are susceptible to infection due to sterile loss of the innate barrier function of the skin and dermal appendages, facilitating the development of microbial communities, referred to as biofilms, within the wound environment. Microbial biofilms are implicated in both the infection of wounds and failure of those wounds to heal. The aim of this review is to provide a summary of published papers detailing biofilms in wounds, the effect they have on infection and wound healing, and detailing methods employed for their detection. The studies highlighted within this paper provide evidence that biofilms reside within the chronic wound and represent an important mechanism underlying the observed, delayed healing and infection. The reasons for this include both protease activity and immunological suppression. Furthermore, a lack of responsiveness to an array of antimicrobial agents has been due to the biofilms’ ability to inherently resist antimicrobial agents. It is imperative that effective strategies are developed, tested prospectively, and employed in chronic wounds to support the healing process and to reduce infection rates. It is increasingly apparent that adoption of a biofilm-based management approach to wound care, utilizing the “antibiofilm tool box” of therapies, to kill and prevent reattachment of microorganisms in the biofilm is producing the most positive clinical outcomes and prevention of infection …. full article available for purchase or rent

Plasma Treatment Continues to Evolve in Wound Healing

The German company COLDPLASMATECH specializes in using plasma to treat wounds. Plasma is the fourth state of matter, one substantially less common than gas, liquid or solid. While plasma has been in use in the health care industry for some time, it continues to improve as a possible treatment for wound victims.

 

According to Medical Xpress, COLDPLASMATECH utilizes cold plasma, similar to the kind found in lightning, to treat wounds. Early tests found the material to be tissue tolerable and its temperature allows for physicians to better work with its bioactivity.

 

Cold plasma treatment represents another step forward in plasma being effectively used to treat wounds.

 

Plasma as a wound treatment
In a study that was published in Clinical Plasma Medicine, experts outlined the difficulty in comparing plasma tests. The problem comes in the various sources for plasma as each produces different biological and physical properties. Nevertheless, medical researchers have been compiling data for years, earning an understanding of each plasma and its effectiveness in wound treatment.

 

Part of the drive for pushing plasma research forward is its potential to accelerate the healing process. St. George News highlighted how platelet-rich plasma has been used in healing therapy over the last several decades. However, technological improvements have heightened plasma’s effectiveness, enabling it to be a faster-acting wound treatment … read more

$70,000 Amputation or $250 Offloading Procedure

Please choose one

Easy choice right? Not for the Government of Ontario Canada. The vast majority of the 2,000 amputations that occur per year in that country would be preventable with common offloading practices (total contact casting*). Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario was assured three years ago by government ‘premieres’ that they would begin to cover such procedures … that’s three years or 6,000 legs or $420,000,000 ago. “We’re willing to pay for the amputations but we’re not willing to pay for the prevention,” offered Grinspun.

Cost and human suffering aside, mortality rates jump significantly after an amputation especially in older patients, diabetes further increases mortality rates. In one rather grim study** 390 patients that had undergone lower extremity amputations were reviewed, of the patients with diabetes “the median time to death was 27.2 months“.

So if you are suffering from diabetic neuropathy and experience a diabetic foot ulcer and happen to be living in Ontario Canada you need to get your affairs in order. But there is hope as The Ontario Health Technology Advisory Committee is currently assessing total contact casting to treat foot ulcers, check back in three years.
original article

*total contact casting is considered “The Gold Standard of off-loading”. A comparison of the three major off-loading methods (total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes) reinforces this point. The proportions of healing for patients treated with TCC, RCW, and half-shoe were 89.5, 65.0, and 58.3%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities.

**Mortality and Hospitalization in Patients After Amputation
http://care.diabetesjournals.org/content/29/10/2252.full 

Off-Loading the Diabetic Foot Wound
A randomized clinical trial
http://care.diabetesjournals.org/content/24/6/1019.long

Biofilms and Inflammation in Chronic Wounds

Abstract

Significance

The incidence, cost, morbidity, and mortality associated with non-healing of chronic skin wounds are dramatic. With the increasing numbers of people with obesity, chronic medical conditions, and an increasing life expectancy, the healthcare cost of non-healing ulcers has recently been estimated at $25 billion annually in the United States. The role played by bacterial biofilm in chronic wounds has been emphasized in recent years, particularly in the context of the prolongation of the inflammatory phase of repair.

Recent Advances

Rapid high-throughput genomic approaches have revolutionized the ability to identify and quantify microbial organisms from wounds. Defining bacterial genomes and using genetic approaches to knock out specific bacterial functions, then studying bacterial survival on cutaneous wounds is a promising strategy for understanding which genes are essential for pathogenicity.

Critical Issues

When an animal sustains a cutaneous wound, understanding mechanisms involved in adaptations by bacteria and adaptations by the host in the struggle for survival is central to development of interventions that favor the host.

Future Directions

Characterization of microbiomes of clinically well characterized chronic human wounds is now under way. The use of in vivo models of biofilm-infected cutaneous wounds will permit the study of the mechanisms needed for biofilm formation, persistence, and potential synergistic interactions among bacteria. A more complete understanding of bacterial survival mechanisms and how microbes influence host repair mechanisms are likely to provide targets for chronic wound therapy.

full article

Researchers observe ‘paramedic’ ants treating their injured

IVORY COAST, Africa —Researchers observed a species of insect that has its very own first responders who treat their comrades after raids on termites.

 

The Guardian reported that African Matabele ants, which often become injured while launching raids on termites they hunt for food, are cared for by “paramedic” ants that clean their wounds, carry them home and maybe even administer antibiotics.

 

“What we show, for first time in the animal kingdom, is a proper treatment focused on a wound,” University of Wurzburg behavioral ecologist Erik Frank said. “We have anecdotal observations of wound care in other animals, but none that have been studied scientifically.”

full article …

Researchers are Creating an App to Track and Analyze Chronic Wounds

With a $1.6 million award from the National Institutes of Health, an interdisciplinary research team at Worcester Polytechnic Institute is developing a smartphone app that could lower healthcare costs and improve care.

 

An interdisciplinary team of researchers at Worcester Polytechnic Institute (WPI) has received a four-year, $1.6 million award from the National Institutes of Health (NIH) to develop a smartphone app that will allow patients and their caregivers to track and assess chronic wounds, helping lower costs associated with frequent doctor and hospital visits, and catching serious complications before they lead to expensive hospitalizations and life-altering amputations.

 

Emmanuel Agu, associate professor of computer science and coordinator of WPI’s Mobile Graphics Research Group, is the principal investigator for the project. Co-principal investigators include Diane Strong, a professor in WPI’s Foisie Business School, Bengisu Tulu, an associate professor in the Foisie Business School, and Peder Pedersen, a retired professor of electrical and computer engineering.

 

The app, which is in the early development stage, is being designed to be used by patients and caregivers, including visiting nurses, who need to regularly check the status of potentially dangerous wounds in the home environment. It will make patients more involved in their own care, cut down on unnecessary doctor visits, and issue alerts when an emergency trip to the doctor or hospital is necessary, Agu said.

 

A 2017 study found that chronic, nonhealing wounds affect 5.7 million people in the United States, or about 2 percent of the population, at an annual cost of $20 billion. The cost of just transporting chronic wound patients to medical visits is estimated at about $200 million per year. “This is a big problem,” said Agu. “Wounds, wound management, and amputations have a huge cost, both financially and physically, for the people who suffer from them, as well as for their families. I like to work on real problems that make a difference for people. Much of my research is in imaging and computer graphics. Wound management is a problem that imaging technology can help with.”

 

Patients or their caregivers will use the app to photograph chronic wounds with a smartphone. Machine learning algorithms built into the app will measure wound assessment metrics, including size, depth, and color, which indicate how the wound healing is progressing. The algorithms will compare the readings over time to determine if the wound is shrinking or expanding, or if there are other changes, like darkening tissue, that could indicate a growing infection or other complication. The app will also compute a healing score that tells the patient whether the wound is getting better, is unchanged, or is worsening. Finally, the app will suggest one of three actions: stay the course, consult a wound specialist for advice regarding treatment, or seek immediate care.

 

The new wound app is an evolution of work Agu and his research team completed for Sugar, an app designed to help people with diabetes track and manage their weight and blood sugar levels, and also photograph and assess the status of any chronic foot ulcers. In the current research, Agu will build on the wound assessment component of Sugar, which was developed with a $1.2 million grant awarded in 2011 by the National Science Foundation (NSF). And while Sugar focused exclusively on diabetic wounds on the feet and legs, the new app is expected to one day be expanded to assess a broader array of chronic wounds, including arterial, venous, and pressure ulcers, also known as bed sores.

 

Agu, Pedersen, and Clifford Lindsay, assistant professor of radiology at University of Massachusetts Medical School, will lead an effort to address one of the key technical challenges of the new project: processing imperfect smartphone photos taken by amateurs. Agu said his team understands that patients are likely to take photos from too far away or too close up, from an angle, or under poor lighting. He said shadows are particularly problematic for wound analysis, because they affect how the computer vision algorithm perceives the wound’s colors and depth.

 

To address this problem, the team will develop algorithms similar to those used in facial recognition software that can transform each image so it appears as if it was taken straight on, at the proper distance, and under ideal lighting conditions. They will use techniques from an area of computer science called computational photography. “Computational photography has been applied to natural images, like landscapes, but not in the medical domain,” Agu said. “This is cutting-edge research that we believe will produce a good solution to this problem.”

 

In addition to fixing the images, the research team will need to train their algorithms to properly assess and interpret them, work that will draw on the decision support expertise of Strong and Tulu. The team will expose their algorithms to hundreds of images of actual wounds taken, with patient consent, by Lindsay. Raymond Dunn ‘78, chief of plastic and reconstructive surgery at UMass Memorial, is a consultant to the project.

 

Agu and the team will feed the photos, along with wound care specialists’ expert assessments of the wounds and what kind of treatments they require, into the machine learning system so the app will “learn” how to analyze the wounds and calculate what care advice to give. Agu’s team will also test the algorithms on realistic simulated wounds they create with special 3D printers.

 

“This won’t replace doctor visits entirely, but it will augment those visits,” said Agu. “Patients or caregivers can check in anytime they want using this app and get more feedback than they do with occasional doctor visits. If people self-monitor, they are more likely to change their behavior, keep a closer eye on their wounds, and take the proper care those dangerous wounds need.”

 

The wound app is being developed on the Android platform, but Agu expects it ultimately to be adapted for the iPhone platform as well.

 

About Worcester Polytechnic Institute

 

Founded in 1865 in Worcester, Mass., WPI is one of the nation’s first engineering and technology universities. Its 14 academic departments offer more than 50 undergraduate and graduate degree programs in science, engineering, technology, business, the social sciences, and the humanities and arts, leading to bachelor’s, master’s and doctoral degrees. WPI’s talented faculty work with students on interdisciplinary research that seeks solutions to important and socially relevant problems in fields as diverse as the life sciences and bioengineering, energy, information security, materials processing, and robotics. Students also have the opportunity to make a difference to communities and organizations around the world through the university’s innovative Global Projects Program. There are more than 40 WPI project centers throughout the Americas, Africa, Asia-Pacific, and Europe.

 

Contact:
Alison Duffy, Director of Public Relations
Worcester Polytechnic Institute
Worcester, Massachusetts
508-340-5040, amduffy(at)wpi(dot)edu

 

For the original version on PRWeb visit: http://www.prweb.com/releases/2018/02/prweb15232174.htm

TIME to face the challenge of wound infection

Complex wounds, Events, Infection | Schulke
TIME to face the challenge of wound infection.
This microsite follows on from the plenary session,
chaired by Kath Vowden at the Wounds UK conference, Harrogate 2016.

Click here to view the microsite

NEW WOUND CARE CERTIFICATE COURSE

This course is ideal for beginners or anyone looking to brush up on their wound management skills! This wound care certificate course will serve as the basis for evidence-based wound management.

 

Foundation for Wound Care Knowledge
Based off of our expertise and valuable feedback from our past customers, we saw a need for a quick wound care course. This course allows professionals to explore their interests in wound care and decide if they should pursue full wound care certification. Our 23-hour course will provide the foundation to later expand your wound care knowledge and practical management … read more

Wound Care Advantage Introduces the First Referral Source Algorithm in the …

SIERRA MADRE, Calif.–(BUSINESS WIRE)–The prevalence of chronic wounds in the U.S. now impacts 6.5* million people, similar to the number of individuals diagnosed with heart failure. To help its partners increase awareness of their wound care programs in local communities, Wound Care Advantage (WCA) has launched FlightPlan™, the industry’s first referral source algorithm. FlightPlan makes it easy to identify local physicians treating patients who may be in need of advanced wound treatment.

 

“We look for smart ways to develop and integrate technology into all areas of our organization,” said Nick Keezer, CTO of Wound Care Advantage. “FlightPlan was designed around three main objectives: to identify providers or physicians with patients who may need specialized care; to reduce the time it takes for a wound program to connect with the local community; and to better track and manage community education efforts.”

 

Finding local patients that need wound care, when they need it, can be a major challenge for wound center management … read more

UniSA research flying towards healing chronic wounds

Professor Allison Cowin

Professor Allison Cowin, Research Professor, Future Industries Institute, University of South Australia

The same gene which enables flies to fly could hold the answer to healing chronic wounds.

 

Professor Allison Cowin is developing the world’s first human therapeutic antibody for the cytoskeletal protein Flii, also known as ‘Flightless I,’ which has been found to improve wound healing. This medical advancement is game-changing for the treatment of wounds and is particularly valuable for children with the debilitating rare skin condition epidermolysis bullosa (EB).

 

“Our initial experiments have found that Flightless I plays an important role in the development of the skin barrier and thickness – so our antibody has the potential to not only help wounds heal but also to prevent the skin from breaking down again,” Prof Cowin says.

 

The Flii protein was first discovered by geneticists studying fruit flies who found that by removing this particular protein flies could no longer fly – hence the name Flightless … read more

100 Years of Bedsores: How Much Have We Learned?

ABSTRACT Just over 100 years ago, an article was published describing a plan to treat decubitus ulcers that can shed light upon medical progress and current practices. Key prevention and treatment elements included a dedicated ward, staff continuity, frequent position changes and special surfaces, cleanliness, disinfectants, and dressing changes. The necessity of resource allocation and interdisciplinary collaboration was acknowledged. This article sheds light on not only how much we have learned, but also how far we have to go.

 

A little over 100 years ago, a Decubitus Division was established at Kings County Hospital in Brooklyn, New York, and a management plan was published in an article in The Hospital Bulletin of the Department of Public Charities of the City of New York.1 This facility was established as an almshouse for the poor and today is a major municipal hospital affiliated with SUNY Downstate College of Medicine and a level I trauma center. We can learn much by examining this century-old plan for preventing and treating bedsores. To understand components of the plan, it must be remembered that antibiotics were decades in the future, and Dakin solution was still being developed on the battlefields of Europe.2 This article uses the terms “decubitus ulcer” and “bedsore,” as the terms “pressure ulcer” and “pressure injury” were not yet in the medical vocabulary.

read more

A Journey of a Thousand Steps to #ActAgainstAmputation

Diabetes is the sixth leading cause of death in North America. By 2020, an estimated 4.2 million Canadians will be living with the disease and its devastating complications. People with diabetes have an increased risk of developing diabetic foot ulcers (DFUs) as a result of the loss of protective sensation in their extremities. Twenty five percent of individuals with diabetes will have a DFU in their lifetime, increasing their risk of amputation and pushing their five-year mortality rate to surpass that of patients with Hodgkin’s disease, breast cancer or prostate cancer.1,2,3 The direct cost of diabetes in Canada now accounts for about 3.5% of public health-care spending, and this figure continues to rise.4 The cost of DFUs is an enormous strain on health-care systems: about $12.2 billion in 2010. Care for people living with diabetic foot ulcers needs to be holistic and requires addressing all factors that contribute to ulceration, including repeated trauma and pressure. For years, the Canadian wound-care community recognized and understood the importance and value of pressure … read more (pdf)

Iran Unveils Indigenous Polymer Wound Care Dressing


Iranian scientists have managed to produce an artificial vessel and a type of wound care dressing using polymeric materials.

 

The two technological developments were unveiled in a ceremony attended by the Head of Iran Polymer and Petrochemical Institute (IPPI) Mehdi Nekouhesh.

 

The polymer wound care dressing was invented as part of larger plan to find a treatment for a particular type of skin wounds, a Farsi report by Mehr said … read more

A peek under the Cast a Total Contact Casting Primer

a Total Contact Casting Primer with Dr. Michael Miller
(A diatribe in four verses)

 

Okay fans, let’s talk about the science behind Total Contact Casting. But before we talk about the science, what is a Total Contact Cast? Well, before we talk about Total Contact Casting, let’s talk about the key to not just healing wounds but preventing them. But before we talk about preventing and healing them, we need to talk about them … wounds that is.

 

Wound is a term that usually means a defect in the epithelium, which is a five syllable word for skin. Another term you might hear is the word “ulcer”. The simplest way to differentiate these two is to remember that an ulcer arises from the inside and comes out whereas a wound starts on the outside and progresses inside. The key to understanding this is by example’s…

 

The ill equipped robber whose gun fired while he was walking into the store did not receive a gunshot ulcer, he got a gunshot wound. The bullet caused the damage from the outside, in. 

 

The person who took too many aspirin every day and started to have terrible stomach pain did not develop a gastric wound, he developed a gastric ulcer. The lining eroded from the inside out.

 

The beautiful model who could not have her picture taken had a herpes ulcer of her lip, not herpes wound. This ulcer developed from the inside of her lip to the outside

 

The patient who had his hernia fixed and then bumped the incision causing it to open, does not have a stomach ulcer, they have a stomach wound. The incision opened up from the outside exposing the inside.

 

Now that we have the definitions done, back to prevention and treatment. Of course the most obvious question that you need to ask is, what is our diagnosis (diagnoses) for either why this wound developed or what is specifically keeping it from healing?

read more

 

Altered macrophage phenotypes impair wound healing

One of the defining features of chronic wounds is their high levels of inflammation. Patients present with high levels of inflammation, around 80%, of cells at the wound margin being macrophages and with wound fluid laden with proinflammatory cytokines. The latter is in part responsible for preventing wound closure, along with the low levels of growth factors. In healthy acute wounds, two types of macrophages can be found: pro-inflammatory M1 macrophages and antiinflammatory M2 macrophages, with more M1 cells present early post-injury and M2 appearing later to regulate repair and wound closure. This pro-repair M2 phenotype, that secrete a range of mediators including growth factors that regulate re-vascularisation and closure of a wound, is lacking in chronic wounds, leading to excessive inflammation, enhanced degradation within the wound, reduced matrix deposition and lack of closure …  read more

Texas Health Plano Saving More Limbs with Non-Traditional Procedure

More than two million Americans are living as amputees, and that’s expected to double by 2050. In an attempt to change the projection, Texas Health Plano is trying something different. A new and unique catheterization procedure can help salvage the legs of more would-be amputee patients.

 

The multidisciplinary program includes emergency physicians, orthopedic surgeons, wound care physicians, podiatry, internal medicine and interventional cardiology. “The goal is to provide a cohesive plan of care for patients presenting to the ER or wound care center with ischemic ulcers of the legs (or) feet,” says Dr. Vijay Ramanath, medical director of Texas Health Plano’s Limb Preservation Program. “We want to prevent leg (and) foot amputations and return patients to a high-quality of life.” read more

 

How To Ensure Effective Offloading With Total Contact Casting

I recently had the opportunity to speak at a dinner meeting to a group of wound care clinicians. During a question and answer session, the topic of discussion drifted toward the use of total contact casting (TCC). I asked the meeting participants to indicate, with a show a hands, how many of them were using this modality regularly in their practice. I was shocked to see that the number was less than 10 percent.

 

Numerous authors have described the underlying pathology in the development of lower extremity ulcerations. Perhaps one of the greatest difficulties in managing complex lower extremity ulcerations is offloading the wound site effectively. A review of the literature demonstrates that TCC is the “gold standard” for offloading non-infected, non-ischemic plantar foot ulcerations.1,2

 

There are several mechanisms that combine to provide the reduction of peak plantar pressures via the use of TCC. Studies have established that the use of TCC decreases altered gait mechanics with shortened stride length and an overall reduction of walking velocity, both of which contribute to the reduction of plantar pressures.3 Furthermore, given the “cone effect” provided by the physical structure of the patient’s leg (an inverted cone), the TCC (a conical receptacle) also allows more even distribution of the patient’s weight read more

Medicare Changes That May Affect You (Tennessee, Alabama, and Georgia)

The Medicare Administrative Contractor (MAC) for Jurisdiction J (Tennessee, Alabama, and Georgia) is transitioning from Cahaba to Palmetto. The Part A transition went into effect January 26, 2018 and Part A providers should already be submitting claims to Palmetto GBA. Cahaba has discontinued the receipt of Part A redetermination, reopening, and ADR submissions via the InSite Web Portal … read more

Managing chronic venous leg ulcers

what’s the latest evidence?

 

Chronic venous leg ulcers (CVLUs) affect nearly 2.2 million Americans annually, including an estimated 3.6% of people over the age of 65. Given that CVLU risk increases with age, the global incidence is predicted to escalate dramatically because of the growing population of older adults. Annual CVLU treatment-related costs to the U.S. healthcare system alone are upwards of $3.5 billion, which are directly related to long healing times and recurrence rates of over 50%.

 

CVLUs are not only challenging and costly to treat, but the associated morbidity significantly reduces quality of life. That makes it critical for clinicians to choose evidence-based treatment strategies to achieve maximum healing outcomes and minimize recurrence rates of these common debilitating conditions. These strategies, which include compression therapy, specialized dressings, topical and oral medications, and surgery, are used to reduce edema, facilitate healing, and avert recurrence read more

 

Spend a Minute, Save a Life

Inlow’s 60-Second Diabetic Foot Screen

 

Boulton states that “throughout our medical training, we are taught how to manage patients who present with symptoms, which usually leads to a clinical examination, a diagnosis, and a treatment and management plan. However, virtually no time is spent on teaching how to manage patients who have no symptoms because they have lost the ability to feel pain; that is, they have peripheral neuropathy.”1 Clinical experience and the literature1 have shown us that the lack of symptoms Boulton referred to in those with or at risk for diabetic foot complications can have devastating effects on the person, their family and health systems. As clinicians, we have the opportunity, and the obligation, to step in and fill the gap left when peripheral neuropathy is present, or potentially present, in any of our patients. The key is a simple, quick procedure: foot screening … read more

Acute and Impaired Wound Healing

Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care

 

Acute and chronic wounds affect millions of people in the United States and around the world. In recent decades, clinicians have gained a better understanding of the mechanisms of normal wound repair process and causes of delays in healing. This progress has led to significant improvement in the quality of life of affected patients. This article reviews the latest insights and opportunities for wound repair science and innovations in wound care.

 

Acute wounds are a common health problem, with 11 million people affected and approximately 300,000 people hospitalized yearly in the United States. Typically, acute wound healing is a well-organized process leading to predictable tissue repair where platelets, keratinocytes, immune surveillance cells, microvascular cells, and fibroblasts play key roles in the restoration of tissue integrity., The wound repair process can be divided into 4 temporarily and spatially overlapping phases: coagulation, inflammation, formation of granulation tissue (proliferative phase), and remodeling or scar formation phase … read more

 

Topical Nystatin Treatment for Candida Infection

Abstract

Introduction. Wound infection is an important cause of nonhealing wounds and graft rejection. Objective. A series of 5 patients (4 females, 1 male; median age, 50; age range, 1.5–83 years) with nosocomial Candida infection of burns and chronic wounds that were reconstructed with split-thickness skin grafts is presented.

 

Materials and Methods. This case series was carried out between February 2011 and June 2014. Based on tissue cultures, wounds were treated with 100 000 units/mL of nystatin and 25 mg in 500 cc normal saline of mafenide acetate, which resulted in regression of wound infection symptoms and improvement of skin graft take. Conclusions. The authors propose this simple, nontoxic, and economic topical treatment for wounds and skin grafts with positive Candida cultures.

 

Infection is a common local factor that impedes wound healing. Hence, a topical antimicrobial dressing is frequently used to control bacterial proliferation.1 Since the introduction of effective topical antibacterial therapy, fungal infections have become more prevalent, especially in burn patients … read more

Scientists Create New Self-Repairing Material

While some people might think comic books are a fun distraction, they’ve made a difference in the real world. Case in point: Several noteworthy characters have inspired exciting new developments in the wound care industry. In spring 2016, a team of scientists from the UK used the web-shooter of the iconic Spider-Man as the basis for a gun that can create customizable dressings.

 

Now, a group of researchers from the University of California, Riverside have found similar inspiration in Wolverine, a mutant hero with claws and powers of regeneration. It’s the latter ability that most interested the team, and as they detail in a new study in the journal Advanced Materials, they’ve created a self-healing material that has multiple purposes … read more

Venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, pressure …

Are You Confident of the Diagnosis?

 

Leg ulcers are skin lesions with full-thickness loss of epidermis and dermis on the lower extremities. Among a wide variety of etiologies for chronic leg ulcers, four common types are venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, and pressure ulcers. By definition, chronic leg ulcers last greater than 6 weeks. Acute ulcers such as traumatic wounds undergo normal healing in healthy patients without the need for further treatment. As a result, only chronic leg ulcers will be discussed here.

 

Patients with venous leg ulcers commonly complain of swelling and aching of the legs that is worse at the end of the day and improves with leg elevation. The medial lower leg is the most common site. The borders of venous ulcers are typically saucer-shaped, initially with a shallow wound base. The surrounding skin often exhibits pitting edema, induration, hemosiderosis, varicosities, lipodermatosclerosis, atrophie blanche, and/or stasis dermatitis read more

 

Assessing footwear in patients with diabetes

Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration.

 

Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking …  read more

Stratatech Begins Test of Engineered Skin for Diabetic Foot Ulcers

Stratatech is moving forward with tests of a genetically engineered human skin that could heal the sores and wounds many diabetic patients get on their feet.

 

Madison, WI-based Stratatech, a subsidiary of U.K.-based Mallinckrodt (NYSE: MNK), said Wednesday that it had enrolled the first patient in a study of the skin tissue, called ExpressGraft-C9T1.

 

Stratatech said the ExpressGraft skin tissue builds on some of the same technologies the company pioneered in developing StrataGraft, its flagship skin replacement product. StrataGraft is cell-based skin tissue designed to coax the bodies of burn patients into regenerating skin … read more

Ancor Announces Joint Venture with Advanced Tissue

Rock, Arkansas-based Advanced Tissue, the leader in providing third-party reimbursable wound-care products in the United States.

 

Advanced Tissue, founded in 2000, provides advanced surgical dressings based on physician orders, in single-use unit-dose packaging, to patients in both the home as well as in long-term-care facilities. All physician-ordered wound-care supplies are customized per patient, per dressing change. Advanced Tissue simplifies and personalizes the approach to home-based dressing changes by removing the guesswork for the patient with regard to the procurement, frequency and application of the products that have been selected by their physician. This contributes to an increased positive outcome for patients that are compliant with wound-care treatments.

 

Tim McKibben, Ancor Managing Partner, said, “We are thrilled to partner with Advanced Tissue.” He continued, “The Advanced Tissue team has done a tremendous job building a strong and efficiently run company, and we are excited to come alongside and assist in growing Advanced Tissue to the next level. The current management team and ownership will stay in place and continue in their efforts of achieving market share in this constantly changing and growing segment of healthcare.”

read more

 

Wound Care Manual and Clinical Guidelines for Nurses

When faced with a complex instance of wound care, many first time or novice clinicians will ask, ‘What wound is this? What dressing should I use? How will this wound heal?’

 

An aspect of wound care management often overlooked is defining the wound itself. The guiding principles of wound care have always been focused around defining the wound, identifying any associated factors that may influence the healing process, then selecting the appropriate wound dressing or treatment device to meet the aim and aid the healing process.

 

This structured approach is essential, as the most common error in wound care management is rushing in to select the latest and greatest new wound dressings without actually giving thought to wound aetiology, tissue type and immediate aim.

 

This overview of wounds and dressings will identify some of the most common wound types and guide you in setting your aim of care and selecting a product or device to achieve that aim … read more

 

Conducting Your HIPAA-Required Security Risk Assessment

A company based in the state of Pennsylvania that develops wireless technology that’s used to assist physicians in the care of their cardiology patients was recently fined in excess of $2 million for a HIPAA breach that occurred when the protected health information (PHI) belonging to nearly 1,400 individuals was compromised after a company employee’s laptop was stolen.  The Office for Civil Rights (OCR), the body within the U.S. Department of Health & Human Services (HHS) tasked with enforcing HIPAA’s privacy and security rules, found, specifically, that “[the company] had insufficient risk analysis and risk management processes in place at the time the theft occurred; failed to conduct an accurate and thorough risk analysis to assess the potential risks and vulnerabilities to the confidentiality, integrity, and availability of [electronic] PHI (ePHI); and failed to plan for and implement security measures sufficient to reduce those risks and vulnerabilities. (Code of Federal Regulations [CFR] 45 164.308(a)(1)).”  This article will discuss the processes of HIPAA risk analysis and risk management to educate providers in the outpatient wound clinic setting on how to better protect their patients’ PHI and ePHI. The authors will also describe the general process of the security risk assessment (SRA) and offer direction and resources for providers to utilize … read more

 

SIGNS OF WOUND INFECTION THAT EVERYONE SHOULD KNOW

Wound infection is such a common condition and presents so often that every wound care professional will recognize the major signs and symptoms almost instantly. However, the consequences of diagnosing wound infection late, or missing the signs of wound infection completely, are such that it is worth spending a few moments every now and again to remind ourselves of all the signs of wound infection.

 

As we are taught during training, the principal signs of wound infection are rubor, calor, tumor, functio laesa, drainage, and a decline in wound status. Rubor in an infected wound describes a poorly defined erythemal border with a disproportionate amount of erythema, while calor describes a magnified localized increase in temperature with warmth extending further away from the site and a possible systemic increase in body temperature … read more

 

Hyperbaric oxygen add-on may not aid wound healing in diabetes

The addition of hyperbaric oxygen therapy to standard care did not substantially improve outcomes in adults with diabetes with an ischemic wound compared with standard care treatment alone, according to findings published in Diabetes Care.

Dirk T. Ubbink, MD, PhD, of the department of surgery at Academic Medical Center in Amsterdam, and colleagues evaluated data from the DAMO2CLES trial on 120 adults with diabetes and an ischemic wound randomly assigned to standard care with (n = 60) or without hyperbaric oxygen therapy (n = 60) to determine whether hyperbaric oxygen therapy is beneficial for ischemic wound treatment. Participants were recruited between June 2013 and December 2015. The primary outcomes included limb salvage and wound healing after 12 months. Follow-up visits occurred at 3, 6 and 12 months after recruitment … read more

Mathematics Used to Improve Wound Healing

Chandan Sen, a research professor in the surgery department at Ohio State University, teamed up with Avner Friedman, professor of mathematicians at the university, and Chuan Xue, a postdoc at Ohio State’s Mathematical Biosciences Institute, to create a mathematical model for ischemic wounds. This new computational tool should provide predictive guidance on how a given wound might progress, allowing researchers to develop more precise protocols to deal with wounds and dehiscences.

 

The mathematical model, to date, simulates both non-ischemic wounds – those typical of wounds in healthy people with good circulation – and ischemic wounds. The current model produced results that generally match pre-clinical expectations: that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed.

The model also showed that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process … read more

Guidelines for safe negative-pressure wound therapy

Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable negative pressure evenly through a wound filler (foam or gauze). Drainage tubing adheres to an occlusive transparent dressing; drainage is removed through the tubing into a collection canister. NWPT increases local vascularity and oxygenation of the wound bed and reduces edema by removing wound fluid, exudate, and bacteria … read more

Inflammation in Chronic Wounds

Non-healing chronic wounds present a major biological, psychological, social, and financial burden on both individual patients and the broader health system. Pathologically extensive inflammation plays a major role in the disruption of the normal healing cascade. The causes of chronic wounds (venous, arterial, pressure, and diabetic ulcers) can be examined through a juxtaposition of normal healing and the rogue inflammatory response created by the common components within chronic wounds (ageing, hypoxia, ischaemia-reperfusion injury, and bacterial colonisation). Wound bed care through debridement, dressings, and antibiotics currently form the basic mode of treatment. Despite recent setbacks, pharmaceutical adjuncts form an interesting area of research.

 

The skin forms an important and effective barrier against the environment. It plays a vital role in protection against insults such as bacteria, xenobiotics and dehydration. When a cutaneous injury occurs, the body initiates a series of complex events to re-establish this protection. Wound healing can be roughly divided into four continuous and overlapping phases: (1) haemostasis; (2) an immediate inflammatory response defined by an infiltration of cytokine-releasing leukocytes with antimicrobial functions; (3) these cytokines kick off a proliferative phase where new epithelium, blood vessels, and extracellular matrix (ECM) are laid down; (4) over a period of weeks to months, the wound contracts as the ECM is remodelled []. These highly regulated cellular, humoral and molecular processes have been described as an orchestral performance—a potential flawless interplay can lead to perfect regeneration; however, human adult wounds undergo a repair process that leads to scarring, and, in some cases, non-healing chronic wounds ….  read more

Self-sealing miniature ‘wound’ created by engineers

Biomedical engineers have developed a miniature self-sealing model system for studying bleeding and the clotting of wounds. The researchers envision the device as a drug discovery platform and potential diagnostic tool.

 

A description of the system, and representative movies, were published Tuesday online by Nature Communications.

 

Lead author Wilbur Lam, MD, PhD says that blood clotting involves the damaged blood vessel, platelets, blood clotting proteins that form a net-like mesh, and the flow of the blood itself.

 

“Current methods to study blood clotting require isolation of each of these components, which prevents us from seeing the big picture of what’s going with the patient’s blood clotting system,” says Lam, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University read more

Screenshot from video showing blood cells streaming through a “wound” and a clot forming. The red-stained cells are actually white blood cells. A green extracellular glue can be seen at the top of the wound; this is fibrin, which holds the clot together. See the full video at: https://youtu.be/l7k1dGfKG0g

Reducing infection in chronic leg ulcers with an activated carbon cloth dressing

Chronic wounds are likely to have an increased bioburden, which in turn increases the risk of local infection. Indeed, infection is one of the most frequent complications of non-healing wounds, resulting in longer treatment times, increased risk of morbidity, greater resource use (of both dressings and nurse time) and, most importantly, a high personal cost to patients and their families (Cooper et al, 2014). While the ultimate aim is to treat the underlying wound, use of antimicrobial dressings is the cornerstone of the treatment of infected wounds. Most antimicrobial dressings work by killing the bacteria, and are indicated for use only when there are clear signs of increased bioburden and/or clinical signs of infections. As such, their use is assessed after 2 weeks, at which point it is advised that the clinician switches to another type of dressing if the wound is observed to be healing (Cooper et al, 2014) … read more

Unexpected helpers in wound healing

Nerve cells in the skin help wounds to heal. When an injury occurs, cells known as glial cells change into repair cells and disseminate into the wound, where they help the skin to regenerate, researchers from the University of Zurich have shown.

An essential step in skin wound healing is wound closure, which is why shortly after an injury occurs, blood coagulates and seals the wound. For the injury to be able to heal permanently, however, the affected layers of the skin need to be newly formed. For that to happen, a complex, only partially understood interplay takes place between various cell types in our skin. Together with a team from ETH, Lukas Sommer, a professor in the Institute of Anatomy at the University of Zurich … read more

Total Contact Cast Use in Patients With Peripheral Arterial Disease

As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. Objective. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use … read more

CERTIFIED WOUND CARE PROFESSIONALS IN THE IN-HOME HEALTHCARE INDUSTRY

In-home health care is increasingly on the rise. Research shows that 91% of American seniors favor the Medicare home health benefit and 87% of all Americans prefer to receive medical treatment in the comfort of their own home.

Becoming educated in advanced wound care, and achieving an accredited wound care certification can help to skyrocket your career as an independent contractor!

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Cell signals that trigger wound healing are surprisingly complex

In a sharp and pointy world, wound healing is a critical and marvelous process.

 

Despite a tremendous amount of scientific study, many outstanding mysteries still surround the way in which cells in living tissue respond to and repair physical damage.

 

One prominent mystery is exactly how wound-healing is triggered: A better understanding of this process is essential for developing new and improved methods for treating wounds of all types.

 

Using an ultrafast, ultraprecise ultraviolet laser, a team of physicists and biologists at Vanderbilt University has taken an important step toward understanding the nature of these trigger signals. Their new insights are described in a paper titled “Multiple mechanisms drive calcium signal dynamics around laser induced epithelial wounds” published Oct. 3 by the Biophysical Journal read more

Atypical Wounds: Causes and Management

Part 1 in a series discussing the etiology, assessment and management of atypical wounds.

As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

An atypical wound, also known as a wound of unknown etiology, is caused by a disease or condition that doesn’t cause a wound typically …. read more

DermaStream CST for Active Wound Management

Israel21C is reporting that EnzySurge out of Rosh Ha’ayin, Israel is expecting to begin FDA approval process for the complete DermaStream CST system. The wound healing device is designed to be placed over a wound to provide continuous cleaning and washing away of debris and extravasated fluid. Although the device itself received FDA clearance, the bio-active chemical solution that it is supposed to work with it has yet to get a green light … read more

Technology for Improved Wound Management

How can your organization improve wound outcomes while decreasing costs? Learn how AMG Long Term Acute Care Specialty Hospital is using technology to achieve better wound management with fewer resources. Jennifer Wallace RN, BSN, the CEO of AMG Greenwood, presents strategies to improve wound management.

What you need to know about transparent film dressings

By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS

Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes.

Transparent film dressings provide a moist, healing environment; promote autolytic debridement; protect the wound from mechanical trauma and bacterial invasion; and act as a blister roof or “second skin.” Because they’re flexible, these dressings can conform to wounds located in awkward locations such as the elbow. The transparency makes it easy to visualize the wound bed … read more

True impact of diabetic foot ulcers

The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research … More than half the patients in the research study did not see their ulcer heal over a year — and one in seven had to have part or all of their foot amputated … Foot ulcers are open wounds and they affect around a quarter of the 3.3 million people in the UK living with diabetes … The wounds develop because diabetes damages the nerves and blood vessels in the feet … These wounds are chronic, slow to heal and prone to infection, and it is infection that normally leads to some of the severe consequences such as losing a limb or multiple amputations … read more

Wound Documentation Dos & Don’ts

Scope of Practice and Standards of Practice guide nurses1 and other members of the interprofessional wound care team2 in caring for patients with wounds. Documentation in the medical record is a key aspect of the Standard of Practice and serves to record he care delivered to the patient. Your documentation should follow your facility guideline for documentation. This WoundSource Trending Topic blog considers general wound documentation dos and don’ts and presents 10 tips for success … read more

New technology for accelerated wound healing discovered

Researchers have found a new way of accelerating wound healing. The technology and the mode of action involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Researchers at Uppsala University and SLU have found a new way of accelerating wound healing. The technology and the mode of action method published in the highly ranked journal PNAS involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Treatment of large and chronic wounds are a high cost burden to the health care system since effective tools to accelerate healing are lacking. Wound care is today limited to mechanical debridement, use of different dressings and significant amounts of antibiotics preventing or treating wound infections. With the aging population, occurrence of chronic diseases such as diabetes and the alarming global spread of antibiotic resistance, a treatment that kick-starts and accelerates wound healing … read more

Hollister Inc. shifts away from wound care

Hollister Inc. on Feb. 2 announced its decision to divest portions of its wound care business. Hollister, which manufactures products for not only the wound care market, but also the ostomy, continence and critical care markets, is in the process of transitioning its Hydrofera Blue and Endoform businesses to new owners, according to a press release. The new owners, who plan to continue manufacturing and delivering the products, will be named in a “forthcoming” communication, the release says … read more

Grant Funds Development of Wound Healing Glove

A group of researchers from the University of Texas at Arlington received a $227 000 grant from the federal Medical Technology Enterprise Consortium to develop the REHEAL glove. This bioengineered glove is a flexible, polymeric wound dressing made of a transparent silicone for the treatment of hand trauma. The innovative product can provide negative pressure would therapy as well as deliver therapeutics such as topical gels and irrigation. In addition, the glove allows for greater hand mobilization in the earlier phases of wound healing, which in turn accelerates rehabilitation. Previous studies have demonstrated the safety and feasibility of the product for improving patient care.​

Visit https://www.eurekalert.org/pub_releases/2018-01/uota-umb013118.php for more information.

(from todayswoundclinic.com)

Green Fluorescent Protein Helps Therapeutic Proteins …..

Researchers from Harvard University seem to have created a method to overcome the challenge of getting specific proteins to enter mammalian cells through the typically very restrictive cell membranes. The scientists achieved this feat by using highly positive ionizing green fluorescent protein (GFP) and attaching a ligand protein to it. Because of the high positive charge on the GFP, the package gets sucked into the cell’s interior by the negatively charged intracellular molecules called proteoglycans. It is hoped that this methodology will make protein based drugs a lot more effective, as currently they have to rely on doing their signaling work while remaining outside the cell … read more

Seeking Advice Can Be The Foundation of Optimal Wound Care

I purchased a rental home that needed an extensive renovation from the get-go 15 years ago. This same house recently required a complete re-renovation due to extensive moisture damage. I am someone who loves a good challenge, and so I gutted this property not only because it was necessary to make the home livable, but because I was in search of answers as to the “what,” “where,” “why,” and “how” everything came to be. As of this writing, my work on the house is (at least for the time being) finished, the result is better than I had expected, and I believe future problems will be prevented. During this long and physically, emotionally, and financially painful journey, which turned up everything from sluggish and corroded galvanized pipes to rain-damaged structures, many questions were raised in my mind that seemed all too familiar to the questions I ask myself while working as a healthcare clinician, such as: How often do we truly get to the underlying cause of our patients’ problems? How many of us are willing to make superficial “repairs” while forgoing the opportunity to “fix” the deeper, serious issues at large? Are we always willing to ask for help when we are unsure of what the best thing for a particular patient may be?

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Amazon, health care and the first American chaebol

Abe Kasbo, CEO, Verasoni Worldwide.

Abe Kasbo, CEO, Verasoni Worldwide.

Amazon’s recent landmark partnership with Berkshire Hathaway and JPMorgan Chase is yet another example of how certain sectors continue to underestimate Amazon’s imagination, never mind business prowess. I honestly believe some businesses, though fully capable, simply do not know how to respond to Amazon, and therefore don’t even try. Or they may want to try, but are afraid to fail. Amazon has led the way in industries where there’s prodigious inertia, like retail, entertainment, grocery and now health care.

 

The announcement, which is short on details, spurred a sell-off in some of health care’s most popular stocks like CVS, Cardinal Health, Walgreen and United Healthcare, among others. If the Whole Foods acquisition wasn’t a wakeup call, this particular venture into health care is a shot across the bow to every industry in America. It seems the financial markets were nervous that Amazon and partners will do what no American government could achieve to date: get better control of health care costs and deliver efficiencies and results where they matter. The cornerstone of the announcement, in my estimation, is the intention by this coalition to deliver health care “free from profit-making incentives.” American health care’s long resistance to price transparency seems to be have been dealt a blow with this announcement and that is a good thing for patients, and for health care providers, who can now compete on price, experience and outcomes … read more

Effective Wound Dressing Securement for Infection Prevention

In order to promote rapid healing, improve patient comfort and prevent complications, it is important that healthcare professionals actively work to prevent infection. One key component of that effort is wound dressing securement. Secure, gentle and effective dressings can help prevent the ingress of foreign material, reduce damage during dressing changes and help foster an ideal healing environment. This can help reduce the risk of infection, improving patient outcomes and lowering costs.1 In this post, we will explore the importance of infection prevention and effective dressing securement strategies to help prevent infection … read more

Venous Ulcers: The Evidence for Intervention

Even with optimal treatment of venous ulcers, healing may be prolonged and/or ineffective, and recurrence rates remain quite high. How should wound care clinicians and vascular specialists collaborate with care planning? Venous ulceration represents the most advanced stage of chronic venous disease and is responsible for approximately 70% of all chronic leg ulcers.1-3 These ulcers affect approximately 1% of the population and are responsible for significant morbidity, decreased quality of life, and economic costs. Advanced venous disease may result from primary degenerative disorders or may be secondary to a previous episode of deep vein thrombosis (DVT). Additionally, venous ulceration may arise from venous valvular incompetence (reflux) in the superficial, deep, or perforating veins; from venous obstruction; or from a combination of both. Regardless of the underlying etiology, the final consequence is venous hypertension resulting in activation of the microvascular endothelium; leukocyte activation, adhesion, and migration; and inflammation ultimately leading to skin changes and ulceration … read more

The Death of the Kennedy Terminal Ulcer

The concept of the Kennedy Terminal Ulcer (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur …. read more

International Conference on Wound Care, Tissue Repair and Regenerative Medicine
London, UK
June 14-15, 2018

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