Think a Patient Has Rights? They Left.

March 25, 2017February 25, 2020 Wound Care Advisor

by Dr. Michael Miller

There are few absolutes in my universe. I know that my youngest daughter will gleefully and with full malice (but humorously presented) find something to torment me about every time I see her; referrals from family practice docs arrive well marinated in multiple antibiotics with nary a diagnosis in sight (save for the ubiquitous “infection”); and that regardless of what I recommend, offer, beg, plead, or cajole, that the patient has the complete and total power to make their decisions regarding their care and who provides it. Unless they are deemed by multiple authorities to be incapable of making a decision, until the appropriate paperwork or an emergency situation exists mandating immediate lifesaving action, the ball bounces squarely in their court…or so I thought. (more…)

Jim Nabors Would Just Cry

March 25, 2017February 25, 2020 Wound Care Advisor

by Dr. Michael Miller

For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his always well-received “Back Home in Indiana” as a mantra to that source of pride. Our former Governor “My Man” Mitch Daniels was a genius who, using a combination of intelligence, common sense and the persuasive powers of a midwest Svengali, created an economic model that our neighbors can only lust after. Our medicolegal climate is among the best in the US and well it should be. However, while there are some extraordinary caregivers and facilities here, a recent US News and World Report curiously showed that almost none of our hospitals made their “Best of” lists in any category. That is not to say there is bad care but to not have a single facility in an entire state even achieve an honorable mention gives one pause to reflect. The State newspapers were notoriously quiet on this concerning fact despite their trumpeting of who does what well, when and where. (more…)

Hole-ier than Thou, Evidence Based Regardless of the Evidence

March 25, 2017February 25, 2020 Wound Care Advisor

by Dr. Michael Miller

There are certain phrases that make the hair on the back of my neck stand up. Someone telling me that they are a good Jew, a good Christian, a good Muslim or the ultimate in self serving lies, “I ONLY practice EVIDENCE BASED MEDICINE”. People who are what they claim they are do not need to announce it. A short conversation, watching them work, others opinions about them all answer the question before it is asked. Like the RN who asked for a recent presentation on the true science behind NPWT (no, you don’t really understand it). She made sure to tell me not only that she practiced only EVIDENCE BASED MEDICINE but then gave me several examples which incidentally had absolutely no scientific evidence (save for articles from lots of dabblers doing lots of crazy things to people and writing about them). I am now awaiting her response as she may have to realize that her version of EVIDENCE BASED is no more real than Kim Kardashian’s celebrity. (more…)

Alternate universes – Einstein’s insanity

March 25, 2017February 25, 2020 Wound Care Advisor

I remain absolutely amazed that there are so many people doing the same thing and yet doing it so completely different. Depending on where a patient’s wound care and orders originate from, the care I try to translate from that starting point is always a combination of dressing regimens worthy of computer code in their simplicity. The only thing usually missing is the diagnosis. It’s as though they come from an identical planet in an alternate universe.

The issue is that there is the complete dissociation of what is done for a given wound care problem in one practice setting versus another. Having stayed as far away from hospital-based wound care as possible, I continue to be amazed by hospital wound teams touting their expertise while using two to three times a day dressing changes and therapies that are the antithesis of any identifiable evidence. They actually expect entities receiving their cases (including home healthcare agencies, LTAC, skilled facilities, and others) to copy the identical care scenario regardless of their widely variable situations. In fact, the only constant is the patient and his or her condition. (more…)

Stem Cell Dynamic Therapy Could Heal Wounds

March 4, 2017February 25, 2020 Wound Care Advisor

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”.

Using fat to help wounds heal without scars

January 6, 2017February 25, 2020 Wound Care Advisor

Philadelphia – Doctors have found a way to manipulate wounds to heal as regenerated skin rather than scar tissue. The method involves transforming the most common type of cells found in wounds into fat cells – something that was previously thought to be impossible in humans. Researchers began this work at the Perelman School of Medicine at the University of Pennsylvania, which led to a large-scale, multi-year study in connection with the Plikus Laboratory for Developmental and Regenerative Biology at the University of California, Irvine. They published their findings online in the journal Science on Thursday, January 5th, 2017.Fat cells called adipocytes are normally found in the skin, but they’re lost when wounds heal as scars. The most common cells found in healing wounds are myofibroblasts, which were thought to only form a scar. Scar tissue also does not have any hair follicles associated with it, which is another factor that gives it an abnormal appearance from the rest of the skin. Researchers used these characteristics as the basis for their work – changing the already present myofibroblasts into fat cells that do not cause scarring. (more…)

Skin substitutes: Understanding product differences

December 8, 2016February 25, 2020 Wound Care Advisor

Skin substitutes (also called tissuebased products and dermal replacements) are a boon to chronic wound management when traditional therapies have failed. When selecting skin substitutes for their formularies, wound care professionals have many product options—and many decisions to make.

Repair of skin defects has been a pressing concern for centuries. As early as the 15th century BC, Egyptian physicians chronicled procedures and herbal treatments to heal wounds, including xenografts (skin from another species). The practice of applying allografts (human cadaver skin) to wounds was first documented in 1503. In 1871, autologous skin grafting (skin harvested from the the person with the wound) was tried. Next came epithelial- cell seeding, which involves scraping off the superficial epithelium of healthy skin and transplanting the cells onto the wound. (more…)

Knowing when to ask for help

December 5, 2016February 25, 2020 Wound Care Advisor

As a wound care expert, you’re probably consulted for every eruption, scrape, and opening in a patient’s skin. Occasionally during a patient assessment, you may scratch your head and ask yourself, “What is this? I’ve never seen anything like it.”

Most wound care experts want to help heal everyone, and most of us love a challenge. But when should we step back and consider referring the patient to another clinician? (more…)

Hyperbaric oxygen therapy as adjunct therapy for wound care

August 11, 2016February 25, 2020 Wound Care Advisor

Why would a patient with a wound spend almost 2 hours a day, 5 days a week, in a locked chamber receiving 100% oxygen? The answer is that medical grade hyperbaric oxygen therapy (HBOT) can be a valuable adjunct therapy for selected types of wounds.
In this article, I’ll focus on hospitals and clinics that follow guidelines from the Undersea & Hyperbaric Medical Society as I give you a brief overview of how HBOT works and its use in wound care. (more…)

Who can perform sharp wound debridement?

July 21, 2016February 25, 2020 Wound Care Advisor

Nurses and therapists often wonder if their license permits them to perform sharp wound debridement. Scope of practice varies significantly from state to state, so it’s imperative to check your state for specific guidance, but we can address some of the challenges clinicians face in deciding whether they can perform this valuable service for patients.

Sharp debridement vs. other forms

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

July 20, 2016February 25, 2020 Wound Care Advisor

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…)

Clinical Notes: biofilm, bariatric surgery, statins and more

July 20, 2016February 25, 2020 Wound Care Advisor

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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