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How are you differentiating the “big three”?

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Lower extremity ulcers are often referred as the “big three”—arterial ulcers, venous ulcers, and diabetic foot ulcers. Are you able to properly identify them based on their characteristics? Sometimes, it’s a challenge to differentiate them.

Arterial ulcers tend occur the tips of toes, over phalangeal heads, around the lateral malleolus, on the middle portion of the tibia, and on areas subject to trauma. These ulcers are deep, pale, and often necrotic, with minimal granulation tissue. Surrounding skin commonly is pale, cool, thin, and hairless; toenails tend to be thick. Arterial ulcers tend to be dry with minimal drainage, and often are associated with significant pain. The patient usually has diminished or absent pulses. (more…)

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Measuring wounds

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
An essential part of weekly wound assessment is measuring the wound. It’s vitally important to use a consistent technique every time you measure. The most common type of measurement is linear measurement, also known as the “clock” method. In this technique, you measure the longest length, greatest width, and greatest depth of the wound, using the body as the face of an imaginary clock. Document the longest length using the face of the clock over the wound bed, and then measure the greatest width. On the feet, the heels are always at 12 o’clock and the toes are always 6 o’clock. Document all measurements in centimeters, as L x W x D. Remember—sometimes length is smaller than width. (more…)

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ABIs: Do you or don’t you?

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
You’ve identified your patient’s lower extremity ulcer as a venous ulcer. It has irregular edges, a ruddy wound base, and a moderate amount of drainage. The patient’s bilateral lower extremities are edematous. As a wound care clinician, you know sustained graduated compression is key to healing stasis ulcers and preventing their recurrence. (more…)

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Palliative care patients

Dr. Michael Miller

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC

The World Health Organization defines palliative care as care that affirms life and views death and dying as part of a normal process, intends neither to speed nor delay death, provides relief from pain and other distressing symptoms, and offers support to the patient and family. (more…)

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Long-Term Outcome of Pediatric Traumatic Wound Repair: Suture Versus Tissue Adhesive

Summary

This project is an observational trial investigating wound cosmetic appearance after repair of traumatic skin lacerations in the head area of pediatric patients with two different approaches to skin closure: sutures versus tissue adhesive. Photographs will be taken at two follow-up visits after repair and later encryptedly assessed by external plastic surgeon using standard cosmetic assessment scales. The investigators hypothesize that cosmetic wound outcome will be equivalent in these two wound repair treatment options.

Description

Investigation of the long-term outcome of 400 pediatric patients with traumatic skin lacerations in the head area. After primary wound repair with suture or with tissue adhesive, eligible patients will be enrolled on the emergency department (baseline visit). The second follow-up visit will take place 5-10 days after the baseline visit and the third follow-up visit will be completed 6-12 months after trauma. At both follow-up visits, clinical examination and a brief interview will be performed. Foto documentation is completed at both the baseline and the follow-up visit.

Encrypted foto documentation will be evaluated by blinded external plastic surgeons. Primary Outcome is the cosmetic appearance using standard assessment scales, secondary outcomes are the occurrence of complications, cost-effectiveness and patient’s satisfaction.

Read more at BioPortfolio

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Breaking silos: Effective wound healing means treatment across the continuum

Around 6.5 million patients in the U.S. suffer from chronic wounds, such as pressure injuries or ulcers. Treatment costs $25 billion each year, representing a sizable and growing problem. Despite the wide impact of chronic wounds, it’s rare to see specialized, effective wound care delivered across the care continuum.

A chronic non-healing wound is a surrogate marker for illness. These patients require holistic management of their co-morbidities and continuity across care settings.

Despite this, a great deal of emphasis has been placed on treating wounds as singular events, managed topically with expensive dressings and support surfaces. This is only a small part of wound healing.

As a physician focused solely on wound care, I have learned that we must shift the focus from simply treating the wound to treating the wounded patient. The impact in the post-acute care setting in particular is worthy of evaluation and discussion, as up to 29% of patients in long-term care facilities will experience a pressure ulcer, posing serious legal, financial, and staffing implications.

For those providers working outside long-term care, there is little understanding of challenges facing LTC providers. Acute providers do not often ask, for example, how are my LTC partners reimbursed? How are they staffed? What are the requirements and regulatory pressures they face? Asking these questions would facilitate a more productive dialogue with a focus on collaborative prevention, rather than waiting until a chronic wound occurs in the LTC setting.

Creating an integrated wound care community

To address the needs of the present and growing population of patients with chronic wounds, Healogics developed an integrated wound care community model, to coordinate the wound healing process across all care settings. The program utilizes Healogics Specialty Physicians, a subspecialty group of physicians and providers with extensive training solely focused on wound care.

HSPs provide expert inpatient consultation and ensure safe transition of patients out of the hospital into the appropriate care setting. Because HSPs see the patient regardless of post-discharge venue, patients receive the same quality of care whether they are going home, to a skilled-nursing, assisted living, or LTC setting. Because chronic wounds are surrogate markers for illness, we have realized it’s essential to have an integrated, multi-setting, and multi-disciplinary process to treat the patient and their co-morbidities.

Data collected at a pilot IWCC site in the Midwestern U.S. from 2014 to 2016 revealed very positive trends for chronic wound patients. In the acute care setting, the average length of stay decreased from 9.41 days to 5.64 days, and total cost of care per patient was reduced from $10,670 to $7,248.

We’re excited by these promising results, which were revealed at the American College of Wound Healing and Tissue Repair Conference last December. We look forward to refining and expanding the model by helping our partners in acute and LTC settings standardize their practices, use evidence-based clinical guidelines, mobilize technologies and processes, and pay critical attention to patient safety and value-based outcomes.

When it comes to wound healing, no venue of care should operate alone—an integrated solution that creates continuity for the patient is critical. There are four things LTC facilities can do to break down the silos:

Read more at McKnight’s

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NYU docs use machine learning

Lymphedema causes unsightly swelling in the arms and legs. But researchers Mei Fu and Yao Wang have an idea for catching early symptoms sooner.

Researchers at NYU’s Tandon School of Engineering have teamed up with those from the university’s Rory Meyers College of Nursing to develop a machine-learning algorithm that could help detect a lymphatic system disease before doctors are able to.

There is no cure for lymphedema, only physical exercises that can keep the symptoms in check.

Early detection of the disease would allow for physical therapy that could theoretically stop the disease’s progress enough to never allow it to develop.

“Machine learning will help us to develop an algorithm to determine a patient’s status or predict if they will have a measurable symptom later on,” explained Mei Fu, an associate professor at NYU’s Rory Meyers College of Nursing, by telephone last week. “Each time the patients enter the data, the algorithm will teach itself. Later on, machine learning will probably help us say which treatment is better for which kind of patients.”

Read more at Technically Brooklyn

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Doctor-turned-businesswoman uses technology to help diabetics save their feet

When Dr. Breanne Everett began training to become a plastic surgeon she was shocked by the number of foot problems, including amputations, she was seeing among diabetic patients. She decided to look for a solution.

That led the 32-year-old physician to put her medical training on hold and make the transition into business and technology.

She invented a device to alert diabetic patients before a sore spot on their foot turned into a wound that could cause severe complications.

The Calgary company she founded — Orpyx — developed pressure-sensitive insole technology to feed information to patients and prevent the kinds of wounds that can lead to amputations in diabetics with peripheral neuropathy, which can cause numbness in the feet.

The company’s smart-sole foot protection system is attracting attention around the world with ongoing clinical trials in both the U.S. and U.K. The product is available through the company, which calls it the only device of its type on the market.

Read more at Ottawa Citizen

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Peptide nanofibers keep infections at bay

Researchers have developed a new infection-blocking material made of peptide-containing nanofibers that works against antibiotic-resistant bacteria and could one day be incorporated into wound dressings (ACS Infect. Dis. 2017, DOI: 10.1021/acsinfec​dis.6b00173).

The approach targets bacterial quorum sensing—a mode of chemical communication used by bacteria to detect other bacteria. When they sense that enough of their kind are present, they can mount an infectious attack.

Read more at Chemical and Engineering News

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Stem Cell Dynamic Therapy Could Heal Wounds

It’s necessary for the skin to heal the wounds after getting injured. For the first time, scientists discovered that the changing stem cell dynamics contribute to wound healing. The main purpose of these studies was to understand how stem cells differentiate, migrate, and proliferate to repair the tissue damage after trauma.

A team from Université libre de Bruxelles (ULB) started their research on stem cells. Professor of ULB, Dr. Cédric Blanpain MD/Ph.D, WELBIO investigator and the lead researcher of this study, defined the cellular and molecular mechanisms that play active roles in wound healing. The research report was first published in the Journal of Nature Communications.

The skin of a creature is just like an outer shield which protects the inner tissues and other organs from outer injuries. If somehow the outer shield gets disrupted then body activates a cascade of cellular and molecular event to repair the damage and restore skin integrity. ScienceDaily reported that minor defects in these events lead to improper repair causing acute and chronic wound disorders.

In the new study, scientists revealed that distinct stem cells populations contribute in healing the wound. Although it is not cleared yet how proliferation, differentiation, and migration get balanced by stem cell populations during the healing process. Co-author of this study Dr.Sophie Dekoninck said in a statement,“The molecular characterization of the migrating leading edge suggests that these cells are protecting the stem cells from the infection and mechanical stress allowing a harmonious healing process”.

Read more at The Science Times

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One Doctor Exploring Wound Care on Earth and in Space

In laboratories all across the globe, scientists are uncovering new and exciting breakthroughs in the realm of wound healing.

For instance, a team out of Texas is blinding bacteria to prevent their spread. Meanwhile, a collective of doctors from the U.K. recently developed some intriguing new vacuum tech to treat chronic ulcers. There’s even been research into drug treatments, like how opioids may actually prevent proper wound care.

Each team has taken a different approach or tackled a unique situation or medical ailment, and that ensures a more well-rounded coverage that helps a larger pool of patients. However, few scientists have a more grand scope than Ronke Olabisi, a professor of biomedical engineering at Rutgers University.

Reaching for the stars

As the university explained in a recent press release, Olabisi is hard at work on several projects aimed at improving wound healing both on earth and during manned space missions. During space travel, especially as astronauts spend months at a time in stations, the lack of gravity has a huge impact on the human body. Muscle and bones will actually start to deteriorate, and tissues will lose much of their elasticity. Olabisi’s main goal is to study in-depth why this occurs and how to fix, and she believes she can apply much of the same knowledge to wound care on Earth.

Read more at Advanced Tissue

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Wound Photography – How it Benefits Clinical Documentation

wound photography

Accurate assessment and documentation of wounds is essential for developing a comprehensive plan of care. Photography now plays a key role in wound care. The use of digital photography has enhanced the reliability and accuracy of wound documentation. Though a wound assessment in patient files includes details such as location, depth, odor, condition of surrounding tissue and other details, a visual record can be worth even more.

Digital photography is becoming a more prevalent documentation tool. According to an article published in McKnight’s, forensic nursing experts recommend using photographs to document injury. The photos show both how an injury occurred and how it is healing.

The National Pressure Ulcer Advisory Panel (NPUAP) also supports photography as a more accurate means for assessment of wound dimensions and wound base over time.

A visual confirmation to the written record, these images:

  • Facilitate better diagnosis
  • Enhance clinical documentation
  • Help to monitor the progress of wound healing
  • Help prevent litigation in wound management
  • Allow inter-disciplinary communication among the wound care team

Read more at Wound Wizard

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