Wound Care Essentials: Practice Principles
Wound Care Essentials: Practice Principles Book Review: Wound Care Essentials: Practice Principles - Edited by Sharon Baranoski and Elizabeth A. Ayello Wound Care Essentials: Practice Principles (soft cover) promises to provide evidence-based guidance on wound management and practical advice for all clinicians. The presentation of the material is valuable to the physicians and nurses who provide wound ...
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Lasers in Wound Healing
Lasers in Wound Healing Evidence Corner: Lasers in Wound Healing - Laura L. Bolton, PhD Introduction This month we will examine the evidence on laser stimulation of healing. Laser Stimulation of Healing: A Systematic Cochrane Review Reference: Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Clinical Perspective Laser ablation of the ...
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Is Noncontact Normothermic Wound Therapy Cost Effective for the Treatment of Stages 3 and 4 Pressure Ulcers?
Abstract: Purpose: Chronic pressure ulcers are significant health problems for patients in long-term care facilities. The value of restoring quality of life following a pressure ulcer injury has attracted new treatments. The goal of this study was to examine the incremental cost effectiveness of noncontact normothermic wound therapy (NNWT) relative to the current standard of care for treatment of stages 3 and 4 pressure ulcers. Methods: A Markov cost-effectiveness computer simulation model with hypothetical patients was created. The base case involved a 72-year-old man living in a nursing home with a stage 3 ischial pressure ulcer. Standard care was assumed to include moisture-retentive dressings, a pressure-reducing surface, repositioning, and debridement. A secondary economic analysis of stage 4 pressure ulcers was completed. The main outcome measures were quality-adjusted life years (QALYs) and costs. Results: Randomized clinical trials have found that NNWT (n = 72 patients), in combination with the use of pressure-reducing surfaces and repositioning, decreases the surface area of stages 3 and 4 pressure ulcers by 2.5 fold (SD 59%) over standard care (n = 59 patients). A prospective, randomized trial found the eight-week healing rates for stage 3 ulcers are 71 percent with NNWT and 54 percent for standard care. At these healing rates, our modeling for stage 3 pressure ulcers found that for a 40-month time frame NNWT saves $6,630.00 (SE $98.00) and increases QALYs by 0.10 (SE 0.0005) life years as compared to standard care. For stage 4 pressure ulcers, NNWT saves $15,216.00 (SE $186.00) and increases QALYs by 0.14 (SE 0.001). Conclusions: NNWT in patients with stages 3 and 4 pressure ulcers is an economically attractive intervention. Additional well-controlled clinical trials are necessary to further define the role of NNWT in the care of chronic wounds. Disclosure: This study was funded in part by Augustine Medical Inc., Eden Prairie, Minnesota. The funding organization did not participate in the design, cond
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Wet-to-Dry Gauze Dressings: Fact and Fiction
Abstract: Background. The aims of this research were to identify what actually constitutes a wet-to-dry dressing, explain why it is used, and describe how specialist nurses interpret this technique. Method. A descriptive exploratory questionnaire was sent to a convenience sample of general surgeons in New Hampshire and Vermont. Nine wound, ostomy, and continence nurses were interviewed as key informants. Results. The research showed that wet-to-dry dressings and gauze are commonly prescribed for situations where there is little evidence to support their use, such as with open surgical wounds healing by secondary intention. It demonstrated that there is inconsistency among surgeons and specialist nurses on how the technique should be performed, particularly relating to whether the gauze should be dry or moist when removed. Although 75 percent of respondents had access to more sophisticated dressings, reasons for not using these dressings included conflict with traditional approaches to wound care, lack of education, and cost issues. Conclusion. These data suggests that a more professional multidisciplinary approach to wound care, which is firmly evidence based, needs to be developed.
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Surgical Pearl: A Wound Dressing Tip for Venous Ulcers
Abstract: Venous ulcers are the most common form of leg ulcers. Up to 80% of leg ulcers are the result of chronic venous hypertension, most commonly caused by valvular incompetence. When used with a foam dressing, one commonly used treatment?a multilayer compression wrap?may result in further skin damage. The authors present a method of preventing this occurrence.
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March 2006
2. The absorption tests were carried out for 20 seconds, which is inappropriate for most dressings on the market. In all tests, nonwoven A (AQUACEL® Ag, ConvaTec, Skillman, NJ, USA) comes out the best. The term barrier dressing refers to semi-permeable materials.
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A Technique for the Use of 3D Surface Imaging to Study Wound Dressing Fixation
Abstract: The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as shape, extensibility, and fixing position. A technique was developed to investigate some of the parameters involved in the fixing of dressings for acute and chronic wounds. Representative mobile areas in the upper torso, neck, and leg were chosen for surface modeling. Digital surface photogrammetry was used to obtain surface data for various sites in young, middle-aged, and elderly subjects. In each case, landmarks were used to identify a grid of points in a region of skin, and the relative movements of the points were found following typical movements of the appropriate body part. The amounts and orientation of deformation of the skin were computed and displayed in such a way that some preliminary hypotheses could be made concerning why dressings may fail in practice.
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A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspectives?Part 1
Abstract: The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients? behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the ?constant comparison? approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients? lifestyles. Both ulcer and treatment affected the patient?s mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients? lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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March Industry News
Polyheal Initiates Wound Healing Clinical Study for Treatment of Ulcers in Diabetic Patients Polyheal Ltd. announced initiation of a clinical study of Polyheal 1 for the treatment of chronic foot ulcers in diabetic neuropathic patients. s General Wound Care Franchise Transfers to ETHICON Johnson & Johnson announced recently the transfer of the General Wound Care franchise from Johnson & Johnson Medical, based in Arlington, Texas, to the newly formed Johnson & Johnson Wound Management ...
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Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing [PART 1]
Abstract: Wound healing involves a well-orchestrated, complex process leading to repair of injured tissues. However, chronic wounds do not follow the normal pattern of repair. This is due to underlying physiological problems associated with their development, which unless corrected would continue to cause wound deterioration. The key to effective wound care lies in a combination of three approaches: treatment of underlying medical problems, assessment and treatment of local wound bed, and effective management of any patient-centered concerns. An essential component of this recommended approach is restoration of healthy granulation tissue in the wound bed. Wound bed preparation brings a number of existing procedures, including debridement, treatment of infection, and management of exudate levels, together into a systematic approach to help restore the chronic wound bed environment. The aim of wound bed preparation is to remove the barriers to healing and initiate the repair process. This review explores the scientific rationale behind this concept and examines how wound bed preparation offers healthcare professionals an improved paradigm for the treatment of chronic wounds. By implementing wound bed preparation, the formation of healthy granulation tissue will be optimized and the efficiency of biotechnological therapies improved, which would ultimately reduce the time to wound closure.
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