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Balancing the wheels of life

Have you ever ridden a bicycle with a wobbly wheel? The ride isn’t smooth, and you notice every bump in the road. As you focus on your discomfort, you may be distracted from the beautiful vistas you’re riding past.

Think of the bicycle as your overall health, which carries you through life. For most of us, learning how to ride a bike begins in childhood as we learn to control the wheels. But with more wear and tear on the bike, the once-pleasant ride becomes uncomfortable and sometimes out of balance. (more…)

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Instill instead: Negative pressure wound therapy with instillation for complex wounds

Negative pressure wound therapy (NPWT) uses negative pressure to draw wound edges together, remove edema and infectious material, and promote perfusion and granulation tissue development. The tissue stretch and compression created by negative pressure during NPWT promotes tissue perfusion and granulation tissue development through angiogenesis, cellular proliferation, fibroblast migration, increased production of wound healing proteins, and reduction of wound area. NPWT has been used to improve healing in a variety of wounds, including traumatic injuries, surgical wounds, pressure ulcers, diabetic foot ulcers, and venous stasis ulcers. (more…)

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Doing it cheaply vs. doing what’s best for patients

Sad but true: Much of what we do as healthcare professionals is based on reimbursement. For nearly all the services and products we use in wound care and ostomy management, Medicare, Medicaid, and insurance companies control reimbursement. For many years, these payers have been deciding which interventions, medications, products, and equipment are the best, and then reimbursing only for those items. If we want to use something not on the list, we—or our patients—will have to pay for it out of pocket. (more…)

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Clinical Notes: biofilm, bariatric surgery, statins and more

Management of biofilm recommendations

The Journal of Wound Care has published Recommendations for the management of biofilm: a consensus document,” developed through the Italian Nursing Wound Healing Society.

The panel that created the document identified 10 interventions strongly recommended for clinical practice; however, panel members noted that, “there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence.” (more…)

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Clinician Resources: OSHA, Education Program, Civil Workplace

This issue we focus on resources to help clinicians protect themselves from injuries and engage in a healthier lifestyle.

OSHA safety website

A hospital is one of the most hazardous places to work, according to the Occupational Safety and Health Administration (OSHA). The agency provides a wealth of information on how to protect hospital workers as part of its website Worker Safety in Hospitals: Caring for Our CaregiversPDF resources include:

A fact sheet that helps dispel myths, barriers, and concerns related to safe patient handling

Information on making the case for safe patient handling programs (more…)

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Wise use of antibiotics in patients with wound infections

Antibiotic resistance is a pressing public health threat not only in the United States, but worldwide. According to the World Health Organization (WHO), it is one of the major threats to human health.

Despite these concerns, antibiotics continue to be widely used—and overused. In long-term care, for instance, antibiotics are the most frequently prescribed medications, with as many as 70% of residents receiving one or more courses per year. And antibiotics are consistently ordered for suspected pressure ulcer infections.

Here is what clinicians who care for patients with wounds can do to help reduce antibiotic resistance. (more…)

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Understanding radiation dermatitis

According to the National Cancer Institute, an estimated 1.6 million new cases of cancer will have been diagnosed in the United States in 2015. During the course of their disease, most cancer patients receive radiation therapy.

Delivering high energy in the form of waves or particles, radiation therapy alters the DNA of cancer cells, causing their death. Radiation can be administered either externally or internally (through materials placed into the body). It’s given in fraction doses, with the total recommended dose divided into daily amounts. Treatment, including the total dose, is determined on an individual basis.

Although improvements have been made in delivery of radiation therapy, approximately 95% of patients who receive it experience a skin reaction. What’s more, radiation therapy commonly is given concurrently with chemotherapy or targeted therapy to improve survival, which increases the toxicity risk. (more…)

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Causes, prevention, and treatment of epibole

As full-thickness wounds heal, they begin to fill in from the bottom upward with granulation tissue. At the same time, wound edges contract and pull together, with movement of epithelial tissue toward the center of the wound (contraction). These epithelial cells, arising from either the wound margins or residual dermal epithelial appendages within the wound bed, begin to migrate in leapfrog or train fashion across the wound bed. Horizontal movement stops when cells meet (contact inhibition). The ideal wound edge is attached to and flush with the wound bed, moist and open with the epithelial rim thin, and pale pink to translucent. (more…)

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How to manage peristomal skin problems

For an ostomy pouching system to adhere properly, the skin around the stoma must be dry and intact. Otherwise, peristomal skin problems and skin breakdown around the stoma may occur. In fact, these problems are the most common complications of surgical stomas. They can worsen the patient’s pain and discomfort, diminish quality of life, delay rehabilitation, increase use of ostomy supplies, and raise healthcare costs.

Peristomal skin problems also perpetuate a vicious cycle in ostomy patients: They impair adhesion of the pouching system, which in turn exacerbates the skin problem. That’s why maintaining peristomal skin integrity and addressing skin problems promptly are so crucial. (more…)

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Clinical Notes: Moldable Skin Barrier, hypoglycemia, diabetic food ulcers

Moldable skin barrier effective for elderly patients with ostomy

A study in Gastroenterology Nursing reports that compared to a conventional skin barrier, a moldable skin barrier significantly improves self-care satisfaction scores in elderly patients who have a stoma. The moldable skin barrier also caused less irritant dermatitis and the costs for leakage-proof cream were lower.

The application of a moldable skin barrier in the self-care of elderly ostomy patients” included 104 patients ages 65 to 79 who had a colostomy because of colorectal cancer.

Risk factors for severe hypoglycemia in older adults with diabetes identified

(more…)

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