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Orlov A, Ciliberti M, Somma R, Gefen A. A robotic venous leg ulcer system reveals the benefits of negative pressure wound therapy in effective fluid handling. Int Wound J 2023; 21:e14426. [PMID: 37786996 PMCID: PMC10828725 DOI: 10.1111/iwj.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
We applied a market-leading, single-use negative pressure wound therapy device to a robotic venous leg ulcer system and compared its fluid handling performance with that of standard of care, superabsorbent and foam dressings and compression therapy. For each tested product, we determined a metrics of retained, residual, evaporated and (potential) leaked fluid shares, for three exudate flow regimes representing different possible clinically relevant scenarios. The single-use negative pressure wound therapy system under investigation emerged as the leading treatment option in the aspects of adequate fluid handling and consistent delivery of therapeutic-level wound-bed pressures. The superabsorbent dressing performed reasonably in fluid handling (resulting in some pooling but no leakage), however, it quickly caused excessive wound-bed pressures due to swelling, after less than a day of simulated use. The foam dressing exhibited the poorest fluid handling performance, that is, pooling in the wound-bed as well as occasional leakage, indicating potential inflammation and peri-wound skin maceration risks under real-world clinical use conditions. These laboratory findings highlight the importance of advanced robotic technology as contemporary means to simulate patient and wound behaviours and inform selection of wound care technologies and products, in ways that are impossible to achieve if relying solely on clinical trials and experience.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Marino Ciliberti
- Wound Care Centre (Centro Aziendale di Riparazione Tissutale)Castellammare di StabiaItaly
| | - Rosa Somma
- Wound Care Centre (Centro Aziendale di Riparazione Tissutale)Castellammare di StabiaItaly
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
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Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J 2023; 20:1118-1129. [PMID: 36251505 PMCID: PMC10031221 DOI: 10.1111/iwj.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Coleraine, UK
- School of Nursing and Midwifery, Cardiff University, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Departmnet of Nursing, Lida Institute, Shanghai, China
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ABCDEFGHI Systematic Approach to wound assessment and management. Nursing 2023; 53:16-25. [PMID: 36820688 DOI: 10.1097/01.nurse.0000918548.41494.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
ABSTRACT The ABCDEFGHI approach introduces a systematic approach to wound care. It instructs the clinician to Ask pertinent questions, including those that may identify local and systemic Barriers to wound healing. After obtaining a thorough history, the clinician may proceed to Clean the wound and Do a physical examination, specifically looking for Exposed structures and Factors that will complicate the healing process. Good Healing strategies involving various dressings can then be implemented to promote healing. If necessary, a referral can be made to Involve specialists using various referral pathways. Information used to synthesize this approach was obtained through a review of national and international guidelines and Google Scholar, MEDLINE, and PubMed databases. The ABCDEFGHI approach to wound assessment and management is a simple and easy-to-follow guide that can be easily implemented into practice, thereby improving clinician confidence and competence in wound care.
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Husain S, Nandi A, Simnani FZ, Saha U, Ghosh A, Sinha A, Sahay A, Samal SK, Panda PK, Verma SK. Emerging Trends in Advanced Translational Applications of Silver Nanoparticles: A Progressing Dawn of Nanotechnology. J Funct Biomater 2023; 14:jfb14010047. [PMID: 36662094 PMCID: PMC9863943 DOI: 10.3390/jfb14010047] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Nanoscience has emerged as a fascinating field of science, with its implementation in multiple applications in the form of nanotechnology. Nanotechnology has recently been more impactful in diverse sectors such as the pharmaceutical industry, agriculture sector, and food market. The peculiar properties which make nanoparticles as an asset are their large surface area and their size, which ranges between 1 and 100 nanometers (nm). Various technologies, such as chemical and biological processes, are being used to synthesize nanoparticles. The green chemistry route has become extremely popular due to its use in the synthesis of nanoparticles. Nanomaterials are versatile and impactful in different day to day applications, resulting in their increased utilization and distribution in human cells, tissues, and organs. Owing to the deployment of nanoparticles at a high demand, the need to produce nanoparticles has raised concerns regarding environmentally friendly processes. These processes are meant to produce nanomaterials with improved physiochemical properties that can have significant uses in the fields of medicine, physics, and biochemistry. Among a plethora of nanomaterials, silver nanoparticles have emerged as the most investigated and used nanoparticle. Silver nanoparticles (AgNPs) have become vital entities of study due to their distinctive properties which the scientific society aims to investigate the uses of. The current review addresses the modern expansion of AgNP synthesis, characterization, and mechanism, as well as global applications of AgNPs and their limitations.
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Affiliation(s)
- Shaheen Husain
- Amity Institute of Nanotechnology, Amity University Uttar Pradesh (AUUP), Sector 125, Noida 201313, India
- Correspondence: (S.H.); (S.K.V.)
| | - Aditya Nandi
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
| | | | - Utsa Saha
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
| | - Aishee Ghosh
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
| | - Adrija Sinha
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
| | - Aarya Sahay
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
| | - Shailesh Kumar Samal
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Pritam Kumar Panda
- Condensed Matter Theory Group, Materials Theory Division, Department of Physics and Astronomy, Uppsala University, 75120 Uppsala, Sweden
| | - Suresh K. Verma
- School of Biotechnology, KIIT University, Bhubaneswar 751024, India
- Condensed Matter Theory Group, Materials Theory Division, Department of Physics and Astronomy, Uppsala University, 75120 Uppsala, Sweden
- Correspondence: (S.H.); (S.K.V.)
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Autologous whole blood clot and negative-pressure wound therapy in South Africa: A comparison of the cost and social considerations. S Afr Med J 2022; 112:800-805. [PMID: 36472331 DOI: 10.7196/samj.2022.v112i10.16527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Advanced wound treatment modalities enhance healing of hard-to-heal wounds, decrease the risk of amputations, and improve the quality of life of patients. Modalities have different rates of efficacy and incur different social and financial costs to the individual and the healthcare system. Two such modalities, the autologous whole blood clot (WBC) and negative-pressure wound therapy (NPWT), were compared in the South African (SA) context. The comparison was conducted on hard-to-heal wounds, with a specific focus on diabetic foot ulcers (DFUs). OBJECTIVES To compare the social considerations and financial costs of using autologous WBC v. NPWT in the treatment of DFUs in SA. METHODS Data were obtained based on current supply costs from SA suppliers for the two modalities, the standard of care for both modalities, the number of applications required for each, and social considerations provided by SA wound management clinicians. Wound healing rates were obtained from the published literature. This information was used to calculate costs of two scenarios (scenario 1: low exudate v. scenario 2: high exudate), which were compared over two treatment durations (4 and 12 weeks) for each treatment modality. Calculations included weekly cost of supplies, total cost saved by a patient with a DFU managed with either of the wound therapies, and the difference in total cost saved between the two modalities. Key social considerations were assessed qualitatively from discussions with SA clinicians experienced in both autologous WBC and NPWT, and from published research. RESULTS The cost of supplies per week was ZAR3 250 for autologous WBC and ZAR4 804 for NPWT in scenario 1, and ZAR3 332 and ZAR6 612 in scenario 2. With healing rates over 4 weeks' treatment duration of 19% for autologous WBC and 10% for NPWT, autologous WBC saved ZAR17 719.93, or 9% more than using NPWT, in scenario 1 and ZAR18 381.47, or 10% more, in scenario 2. At 12 weeks' treatment duration, healing rates for autologous WBC and NPWT were 75% and 43%, respectively. In scenario 1, results indicated a 43% cost difference between the two modalities. Autologous WBC had a total cost saving of ZAR61 874.40 compared with NPWT over a period of 12 weeks. In scenario 2, results indicated a 46% cost difference between the two modalities. Autologous WBC had a total cost saving of ZAR70 454.68 compared with NPWT over a period of 12 weeks. One of the identified social considerations is that NPWT needs a reliable supply of electricity to recharge the pump, while autologous WBC does not. CONCLUSION Both modalities are safe and effective in treating hard-to-heal wounds of the lower extremities. Autologous WBC consistently demonstrated better outcomes than NPWT in terms of both healing rate and cost-effectiveness, as well as having some advantages in terms of social considerations in SA.
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Rippon MG, Mikosiński J, Rogers AA. HydroTac-a hydro-responsive wound dressing: a review of the in vitro evidence. J Wound Care 2022; 31:540-547. [PMID: 35797259 DOI: 10.12968/jowc.2022.31.7.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The aim of this review is to identify and summarise the key in vitro evidence available to support the use of HydroTac (HRWD-2) to address specific aspects associated with the treatment of both acute and hard-to-heal wounds. BACKGROUND The provision of a moist wound healing environment to support optimal wound healing has been a basic tenet in wound care since the pioneering work on the benefits of occlusion to support wound healing. Modern wound dressings have adopted the benefits of moist healing through their innovative development. HRWD-2 has been shown in clinical studies to enable and support good healing outcomes and the in vitro evidence in support of this dressing is presented in this article. METHOD An online literature search (supplemented with a manual search of resources not available online) was conducted to identify articles and studies describing in vitro evidence in support of HRWD-2 in aspects important for promoting a healing response in the clinical environment. RESULTS In vitro studies showed that HRWD-2 contributes to balancing moisture levels and enhances the availability of growth factors known to be important for re-epithelialisation. Pre-clinical studies indicate that HRWD-2 enhances wound re-epithelialisation. Together these results suggest that HRWD-2 promotes a moist healing environment leading to the dressing supporting re-epithelialisation. In vitro data indicating an intrinsic lower in vitro adherence of HRWD-2 likely translate clinically to the benefits of an atraumatic wound dressing, including reduced pain (specifically at dressing change). CONCLUSION The in vitro evidence presented in this review supports the successful clinical results reported for HRWD-2 in terms of fluid management, wound healing and pain reduction at dressing change.
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Affiliation(s)
- Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
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Hunt SC, Azad S. ABCDEFGHI Systematic Approach to Wound Assessment and Management. Adv Skin Wound Care 2022; 35:366-374. [PMID: 35723955 DOI: 10.1097/01.asw.0000831064.06943.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE The purpose of this continuing education article is to introduce the ABCDEFGHI approach to wound assessment and management. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish barriers to wound healing.2. Summarize best practices for wound treatment strategies.3. Explain the usefulness of complete blood count results during a wound investigation.4. Identify a major factor to consider when deciding on a referral for wound management.
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Rippon MG, Forster J, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence—part 2. J Wound Care 2022; 31:330-338. [DOI: 10.12968/jowc.2022.31.4.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This narrative clinical review summarises the key evidence in support for the use of a hydro-responsive wound dressing, HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) to address key aspects associated with the treatment of both acute and hard-to-heal wounds. This review demonstrates how HRWD-2 can be used in general to address the challenges presented by a wide range of wound types and skin injuries. It highlights the ability of HRWD-2 to regulate an optimal moist wound environment that promotes wound progression and healing. Key aspects covered in this review include the dressing's ability to: promote certain phases of the wound healing response (for example, re-epithelialisation) address the concepts and needs for wound progression as set out in the TIME wound management framework provide an optimal hydration level reduce tissue trauma and pain at dressing change.
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Affiliation(s)
- Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
| | - Jan Forster
- Wound Center Links der Weser, 28277 Bremen, Germany
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Sterpione F, Mas K, Rippon MG, Rogers AA, Mayeux G, Rigaudier F, Chauvelot P, Robilliart L, Juhel C, Lecomte Y. The clinical impact of hydro-responsive dressings in dynamic wound healing: Part II. J Wound Care 2022; 31:56-67. [PMID: 35077216 DOI: 10.12968/jowc.2022.31.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Over the course of a wound's healing trajectory, whether the wound is acute or hard-to-heal, management is likely to involve the use of several different dressing types. Minimising the complexity of treatment (in terms of dressing usage) would aid clinicians in providing effective wound care but excellent clinical outcomes must remain the primary goal. METHOD This study was an open-labelled, non-comparative study assessing the clinical effectiveness of a coordinated wound dressing treatment regimen. After an initial phase of using a hydro-responsive wound dressing (HydroClean, HRWD-1, PAUL HARTMANN AG, Germany) to cleanse and debride hard-to-heal wounds, the wounds were subsequently treated with either HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) (to maintain healing progression and re-epithelialisation) or RespoSorb (a superabsorbent dressing, PAUL HARTMANN AG, Germany) (to manage moderate-to-high levels of exudate). The Pressure Ulcer Scale for Healing (PUSH) assessment tool was used to measure the wound status over the course of the treatment period and to assess several wound status parameters (for example, wound area, exudate levels and wound characteristics such as level of re-epithelialisation). RESULTS The results from this study demonstrated that wounds treated with HRWD-2 showed a positive healing response when using the PUSH score assessment tool with a significant mean reduction (p<0.0001) in the PUSH score of wounds treated with HRWD-2, with >75% of wounds being closed by the end of the study. This result underlines the effectiveness of HRWD-2 in supporting healing progression. CONCLUSION The results from this study support the coordinated use of HRWDs for the effective management and treatment of a variety of hard-to-heal wounds.
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Affiliation(s)
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK.,Medical Marketing Consultant Daneriver Consultancy Ltd, Holmes Chapel, UK
| | | | | | | | | | | | | | - Yann Lecomte
- CEN Biotech, Dijon, Bourgogne Franche-Comté, France
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Castro CR, Duran BA, González CL. Preparación del lecho de la herida: limpieza segura y eficaz con ácido hipocloroso pH 5.5. J Wound Care 2022; 31:22-31. [PMID: 36789924 DOI: 10.12968/jowc.2022.31.latam_sup_5.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Sinopsis: El objetivo de la limpieza del lecho de la herida es favorecer la remoción de materia extraña, rehidratar el lecho y acelerar el proceso de cicatrización, considerando siempre una evaluación holística del paciente. La limpieza es un paso fundamental en la preparación del lecho de la herida. En los últimos años, se ha intensificado la búsqueda y elaboración de soluciones limpiadoras con el potencial de promover la curación mediante la eliminación de barreras locales para la curación, sin comprometer el tejido sano y/o en formación. Entre ellas, el ácido hipocloroso (HOCl) puro pH 5.5 cumple con los objetivos de la preparación del lecho de la herida y de limpieza terapéutica de forma biocompatible, segura, eficaz y natural. Este artículo tiene por objetivo realizar una revisión de la evidencia existente en relación con las soluciones limpiadoras y los beneficios del HOCl puro pH 5.5. Conflicto de interés: CRC declara no tener conflicto de interés. BAD y CLG son empleadas de Laboratorio UrgoMedical Chile.
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Walker M, Hurlow J. A tale of two alginates. J Wound Care 2021; 30:S29-S36. [PMID: 33573497 DOI: 10.12968/jowc.2021.30.sup2.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND All fibrous wound dressings are considered to have the same action and value to the support of wound healing. Although clear distinction has been accepted between cotton gauze and calcium alginates, there is still no formally recognised distinction between calcium alginates and the more rapidly gelling fibre dressings. METHOD Scientific and clinical evaluations were used to differentiate two different fibrous wound care products. One is derived from polymer extraction of algae (alginate dressings); the other has been manufactured from a uniquely patented carboxymethylation process that produces 100% carboxymethyl cellulose (CMC)-based dressings. Structural differences between these dressings were evaluated with respect to three important areas of wound care management: optimal wound moisture control; the ability to reduce risk of complication by locking away harmful components (e.g. bacteria); and reducing the overall cost of wound care by promoting more efficient use of nursing time. RESULTS Clear differentiation was illustrated through both scientific and clinical evaluations. CONCLUSION This study supports the potential advantages of using a technically advanced fibrous wound dressing over the traditional fibrous alginate wound care product.
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Affiliation(s)
- Mike Walker
- PhD, CBiol, FRSB, Independent Wound Science Consultant; Self-employed
| | - Jennifer Hurlow
- MSc, WOCN, Wound Specialized Advanced Practice Nurse; Advanced Wound Care, Southaven MS, Millington TN, US
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Sibbald RG, Elliott JA, Persaud-Jaimangal R, Goodman L, Armstrong DG, Harley C, Coelho S, Xi N, Evans R, Mayer DO, Zhao X, Heil J, Kotru B, Delmore B, LeBlanc K, Ayello EA, Smart H, Tariq G, Alavi A, Somayaji R. Wound Bed Preparation 2021. Adv Skin Wound Care 2021; 34:183-195. [PMID: 33739948 PMCID: PMC7982138 DOI: 10.1097/01.asw.0000733724.87630.d6] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To present the 2021 update of the Wound Bed Preparation paradigm. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.
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Boersema GC, Smart H, Giaquinto-Cilliers MGC, Mulder M, Weir GR, Bruwer FA, Idensohn PJ, Sander JE, Stavast A, Swart M, Thiart S, Van der Merwe Z. Management of Nonhealable and Maintenance Wounds: A Systematic Integrative Review and Referral Pathway. Adv Skin Wound Care 2021; 34:11-22. [PMID: 33323798 DOI: 10.1097/01.asw.0000722740.93179.9f] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To synthesize the evidence regarding nonhealable and maintenance wound management and propose an interprofessional referral pathway for wound management. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES After participating in this continuing professional development activity, the participant will apply knowledge gained to:1. Identify the ideas from the authors' systematic review that could prove useful in understanding nonhealable and maintenance wound management.2. Select evidence-based management strategies for nonhealable and maintenance wound management. ABSTRACT OBJECTIVEThis systematic integrative review aims to identify, appraise, analyze, and synthesize evidence regarding nonhealable and maintenance wound management to guide clinical practice. An interprofessional referral pathway for wound management is proposed. DATA SOURCES An electronic search of Scopus, Web of Science, PubMed, Academic Search Ultimate, Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature database with Full Text, Health Source: ConsumerEdition, Health Source: Nursing/Academic Edition, and MEDLINE was conducted for publications from 2011 to 2019. Search terms included (nonhealable/nonhealing, chronic, stalled, recurring, delayed healing, hard-to-heal) and wound types most associated with nonhealable or maintenance wounds. Published studies were hand searched by the authors. STUDY SELECTION Studies were appraised using two quality appraisal tools. Thirteen reviews, six best-practice guidelines, three consensus studies, and six original nonexperimental studies were selected. DATA EXTRACTION Data were extracted using a coding framework including treatment of underlying causes, patient-centered concerns, local wound care, alternative outcomes, health dialogue needs, challenges within resource restricted contexts, and prevention. DATA SYNTHESIS Data were clustered by five wound types and local wound bed factors; further, commonalities were identified and reported as themes and subthemes. CONCLUSIONS Strong evidence on the clinical management of nonhealable wounds is limited. Few studies describe outcomes specific to maintenance care. Patient-centered care, timely intervention by skilled healthcare providers, and involvement of the interprofessional team emerged as the central themes of effective management of maintenance and nonhealable wounds.
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Chemical Characterization and Wound Healing Property of Jacaranda decurrens Cham. (Bignoniaceae): An Experimental Study Based on Molecular Mechanisms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4749712. [PMID: 32382292 PMCID: PMC7191437 DOI: 10.1155/2020/4749712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/14/2020] [Indexed: 01/05/2023]
Abstract
Background Jacaranda decurrens Cham., known as carobinha, is prevalent in the Cerrado biome and presents popular use in treatment of dermatological diseases. The present study aimed to investigate the healing action of topical formulation of Jacaranda decurrens Cham. (FtEHJ) in mice cutaneous lesions. Methods Phytochemical analysis of J. decurrens hydroalcoholic extract was carried out by using HPLC-PDA-ESI-MS and FIA-ESI-IT-MSn. Swiss mice were treated topically with formulation base (FtB) or Fibrinase® or ointment FtEHJ (15 mg/g; 50 mg/Kg). At the end of treatment periods, the inflammatory cytokines (TNF-α, IL-1β, and IL-6) in the lesions were measured by using ELISA and gene expression of TGF-β, Collagen I, and Collagen III was demonstrated by RTqPCR method and histological evaluation. Results Ten compounds were identified in the extract, distributed among the classes of flavonoids and triterpenes. Treatment with FtEHJ increased the wound contraction in 24 hours, such as reduction of TNF-α, IL-1β, and IL-6 (pg/mL) cytokines in the lesion. The TGF-β and collagen gene expression was increased and the wound closure accelerated to nine days, with discrete inflammation, collagenization, and accented reepithelialization. Conclusions. The results obtained suggest chemical compounds present in the FtEHJ accelerates wound healing by being a gene expression modulator, and protein content of different molecules are involved in tissue repair.
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Wound Bed Preparation: Lessons from Around the World. Adv Skin Wound Care 2020; 33:63. [DOI: 10.1097/01.asw.0000651604.64525.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Use of Antiseptic and Antibacterial Agents on Wounds and the Skin. LOCAL WOUND CARE FOR DERMATOLOGISTS 2020. [DOI: 10.1007/978-3-030-28872-3_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk mechanisms factor into the development of pressure injuries. The timely recognition of these injuries is imperative. Many treatments exist for pressure injuries but the focus of patient management should be on preventing injury-related complications.
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Kubanov AA, Karamova AE, Albanova VI, Monchakovskaya ES. Therapy of patients with congenital epidermolysis bullosa using modern non-adherent wound dressings. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-1-30-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim. To evaluate the clinical efficacy of modern atraumatic non-adherent wound dressings in patients with congenital epidermolysis bullosa. Materials and methods. The study involved 9 patients diagnosed with congenital epidermolysis bullosa (EB), including 7 women and 2 men aged 21–50 years. All the patients underwent immunofluorescent antigenic mapping of skin biopsies to confirm the clinical diagnosis. External therapy using modern atraumatic non-adherent wound dressings was performed in all the patients. The evaluation of the clinical efficacy of the applied therapy was carried out on the 14th and 30th day in accordance with the following criteria: complete healing of erosions or ulcers; significant improvement (reduction of erosions/ulceration by at least 75 % compared with the baseline data, reduction of exudate, the presence of granulations, reduction of inflammation signs, reduction of pain); improvement (reduction of erosions/ulceration area by less than 75 %, but more than 25 % compared with the baseline data, reduction of exudate, presence of granulations, reduction of inflammation signs, reduction of pain); without change (reduction of erosions/ulceration by less than 25 % or no change compared with the baseline data, a slight decrease in the amount of exudate, no granulations, a slight decrease in inflammation signs, a slight reduction of pain); deterioration (increase in the area of erosions/ulceration, increase in the amount of exudate, the level of inflammation and subjective estimation either increases or remains the same). Results. On the 14th day, 22 out of 58 (37.9 %) erosions were epithelized. The area of 15 erosions was reduced by more than 75 %. The area of 12 erosions (20.6 %) was reduced by more than 25 %, but less than 75 %. The area of 7 (12.25 %) erosions decreased by less than 25 %. The area of 2 erosions in patients with severe generalised recessive dystrophic epidermolysis bullosa (RDEB) increased (3.45 %). Out of 36 erosions that had not been epithelized by the 14th day, 20 (55.5 %) achieved complete healing by the 30th day. The dimensions and characteristics of 5 (13.8 %) nonhealing erosive-ulcerative defects had remained unchanged by the 30th day. The share of reduction in the area of these defects did not exceed 30 %. Conclusion. The obtained results demonstrate the clinical efficacy of external therapy using modern atraumatic nonadherent wound dressings. The dynamic observation of erosive-ulcerative defects, regular documentation of changes in the parameters of erosive and ulcerative defects allows the development of standardised approaches of efficient external therapy in such conditions, including the selection of non-adherent dressings. Objective assessment of the dynamics of erosive-ulcerative skin defects contributes to the development of individualized plans for treating EB patients.
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Affiliation(s)
- A. A. Kubanov
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. I. Albanova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation;
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - E. S. Monchakovskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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Dowsett C, Hall Y. T.I.M.E to improve patient outcomes: optimising wound care through a clinical decision support tool. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S17-S21. [PMID: 30925234 DOI: 10.12968/bjon.2019.28.6.s17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Caroline Dowsett
- Clinical Nurse Specialist Tissue Viability, East London NHS Foundation Trust and Independent Nurse Consultant in Tissue Viability
| | - Yvonne Hall
- Vascular Clinical Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust
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Moore Z, Dowsett C, Smith G, Atkin L, Bain M, Lahmann NA, Schultz GS, Swanson T, Vowden P, Weir D, Zmuda A, Jaimes H. TIME CDST: an updated tool to address the current challenges in wound care. J Wound Care 2019; 28:154-161. [DOI: 10.12968/jowc.2019.28.3.154] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Leanne Atkin
- Mid Yorkshire NHS Trust/University of Huddersfield, UK
| | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Gregory S. Schultz
- Professor of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, US
| | | | - Peter Vowden
- Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centres, Buffalo, New York, US
| | - Ann Zmuda
- Associate Professor, University of Chicago, Illinois, US
| | - Henry Jaimes
- Global Medical Director Wounds, Smith & Nephew, London, UK
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Dowsett C. T.I.M.E. to improve patient outcomes: use of a clinical decision support tool to optimise wound care. Br J Community Nurs 2019; 24:S6-S11. [PMID: 30817187 DOI: 10.12968/bjcn.2019.24.sup3.s6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients with wounds pose an important healthcare challenge. Many of these wounds are managed in community care and can take weeks or months to resolve. Delays in wound healing can be perpetuated by clinicians who make poor treatment choices, fail to recognise complications and/or do not seek timely advice. Improving patient outcomes requires a proactive approach to care that includes accurate and timely assessment and re-assessment, treatment of the underlying cause using a multidisciplinary team approach and the use of evidence-based practice and clinical judgement to develop an appropriate treatment plan. A structured approach to care, such as the newly developed T.I.M.E. clinical decision support tool, has the potential to improve wound healing outcomes and reduce the burden of chronic wounds in community nursing services.
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Affiliation(s)
- Caroline Dowsett
- Clinical Nurse Specialist Tissue Viability, East London NHS Foundation Trust and Independent Nurse Consultant in Tissue Viability
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22
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Improved Communication Facilitates Chronic Wound Care for Patients, Families, and Professionals. Adv Skin Wound Care 2018; 31:485. [DOI: 10.1097/01.asw.0000546578.64802.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
GENERAL PURPOSE To provide information on the use of topical antimicrobial agents for the treatment of chronic wounds. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Examine features of wounds and wound healing as well as the purpose of specific antimicrobial agents.2. Identify potential therapeutic and adverse effects of specific topical antimicrobial agents for the treatment of chronic wounds. ABSTRACT Bacteria can delay or prevent healing in the surface compartment of a chronic wound or invade the deep and surrounding structures. This article focuses on the superficial compartment and the appropriate use of topical antimicrobial therapies. The authors have reviewed the published evidence for the last 5 years (2012-2017) and extrapolated findings to clinical practice with critical appraisal and synthesis of the recent literature with expert opinion, patient-centered concerns, and healthcare systems perspectives. Summary evidence tables for commonly used topical antimicrobials are included.
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24
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Souery WN, Bishop CJ. Clinically advancing and promising polymer-based therapeutics. Acta Biomater 2018; 67:1-20. [PMID: 29246651 DOI: 10.1016/j.actbio.2017.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/11/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
In this review article, we will examine the history of polymers and their evolution from provisional World War II materials to medical therapeutics. To provide a comprehensive look at the current state of polymer-based therapeutics, we will classify technologies according to targeted areas of interest, including central nervous system-based and intraocular-, gastrointestinal-, cardiovascular-, dermal-, reproductive-, skeletal-, and neoplastic-based systems. Within each of these areas, we will consider several examples of novel, clinically available polymer-based therapeutics; in addition, this review will also include a discussion of developing therapies, ranging from the in vivo to clinical trial stage, for each targeted area of treatment. Finally, we will emphasize areas of patient care in need of more effective, accessible, and targeted treatment approaches where polymer-based therapeutics may offer potential solutions.
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Affiliation(s)
- Whitney N Souery
- Department of Biomedical Engineering, Texas A&M University, Emerging Technologies Building, 101 Bizzell St., College Station, TX 77843, USA
| | - Corey J Bishop
- Department of Biomedical Engineering, Texas A&M University, Emerging Technologies Building, 101 Bizzell St., College Station, TX 77843, USA.
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The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: A retrospective cohort study. PLoS One 2017; 12:e0185251. [PMID: 28949996 PMCID: PMC5614568 DOI: 10.1371/journal.pone.0185251] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/08/2017] [Indexed: 12/30/2022] Open
Abstract
Background Diabetic foot ulcers (DFU) are increasingly prevalent, and associated with significant morbidity, mortality, and cost. An interprofessional approach to DFU management is critical given the etiological complexity involved. This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management for a cohort of patients receiving treatment in an Ontario Canada home care setting. Methods A retrospective cohort study of patients attending a large regional Community Care Access Centre (CCAC) between February 11, 2013-September 30, 2014 was conducted. Following CCAC referral, patients were assessed by an interprofessional team at the Toronto Regional Wound Healing Centre (TRWHC). Those aged > 18 years with a DFU of > 6 weeks duration were included. The primary outcome was the precision of the initial diagnosis relating to DFU etiology (i.e. neuropathic, ischemic or mixed etiology). Secondary outcomes included wound healing, and infection parameters. Analysis was completed with STATA 13.1 (College Stn., TX) of pre-determined outcomes with 2 sided α of 0.05. Results A total of 308 patients were screened, and 49 patients (67.3% male) of mean age 64.2 years (SD 13.7) with a diagnosis of DFU > 6 weeks duration were included for analysis. Of these, 95% were referred with unspecified DFU, and were reclassified to a precise diagnosis relating to etiology, including neuropathy, ischemia or neuroischemic etiology following TRWHC assessment (p < 0.001). For secondary outcomes post-assessment, healability assessment was conducted for a greater proportion of patients (100% versus 44%, p < 0.001). Infection was identified in a greater number of patients (p = 0.04), and of the 35 patients, 94.5% had deep and surrounding infection, and 88.0% were initiated on systemic antibiotics. Vascular insufficiency was diagnosed in an additional 14.3% of the cohort (p = 0.03). Offloading/footwear assessment was conducted in all patients compared with 30.6% prior to referral (p < 0.001) Dressing change frequency decreased significantly following TRWHC assessment (pre: 4.31/week; post: 3.54/week; p = 0.03). Pain scores decreased (2.18 to 1.67) on the numerical rating scale but this was not statistically significant at the final TRWHC assessment. Notably, 36.7% (18/49) reported improved quality of life by the second TRWHC encounter. Conclusions Interprofessional care teams are associated with improved diagnostic acumen and wound healing outcomes over conventional community care services. Initiatives including best practice interprofessional diabetic foot care pathways are recommended with timely vascular management of ischemia, treatment of deep and surrounding infection as well as the availability of foot care and footwear.
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26
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Lourenço SDM, de Oliveira MG. Topical photochemical nitric oxide release from porous poly(vinyl alcohol) membrane for visible light modulation of dermal vasodilation. J Photochem Photobiol A Chem 2017. [DOI: 10.1016/j.jphotochem.2017.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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From Inflammation to Current and Alternative Therapies Involved in Wound Healing. Int J Inflam 2017; 2017:3406215. [PMID: 28811953 PMCID: PMC5547704 DOI: 10.1155/2017/3406215] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 02/08/2023] Open
Abstract
Wound healing is a complex event that develops in three overlapping phases: inflammatory, proliferative, and remodeling. These phases are distinct in function and histological characteristics. However, they depend on the interaction of cytokines, growth factors, chemokines, and chemical mediators from cells to perform regulatory events. In this article, we will review the pathway in the skin healing cascade, relating the major chemical inflammatory mediators, cellular and molecular, as well as demonstrating the local and systemic factors that interfere in healing and disorders associated with tissue repair deficiency. Finally, we will discuss the current therapeutic interventions in the wounds treatment, and the alternative therapies used as promising results in the development of new products with healing potential.
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28
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Abstract
The abstract book contains the abstracts of keynote lectures, focus sessions, symposia, workshops, AIUC annual meeting, AISLEC annual meeting, EPUAP annual meeting, ETRS special session, sponsor symposia, oral presentations, poster presentations and the subject index.
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29
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Scientific and Clinical Abstracts From the WOCN® Society's 49th Annual Conference. J Wound Ostomy Continence Nurs 2017. [DOI: 10.1097/won.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Sibbald RG, Elliott JA. The role of Inadine in wound care: a consensus document. Int Wound J 2017; 14:316-321. [PMID: 27094360 PMCID: PMC7949561 DOI: 10.1111/iwj.12602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/10/2016] [Indexed: 12/17/2022] Open
Abstract
Iodine-based products are antibacterial. The small iodine molecular size is ideally suited to treat surface critical colonisation. Inadine is a 10% povidone iodine dressing with the equivalent of 1% available iodine that is easily extracted from the viscose backing by serum or exudate. The use of hydrophilic polyethylene glycol tulle dressing delivery vehicle allows the dressing to be easily removed by irrigation with potable water or saline. In this study, we developed a short online survey completed by 23 wound-care key opinion leaders from the nursing, medical and podiatry professions. A computerised modified Delphi technique was used to achieve 80% consensus on 11 statements related to the utility and everyday topical wound-care use of this product.
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Affiliation(s)
- R. Gary Sibbald
- Professor of Faculty of Medicine and Public HealthUniversity of TorontoONCanada
- International Interprofessional Wound Care Course and Masters of ScienceCommunity Health (Prevention & Wound Care)TorontoONCanada
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31
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Ousey K, Cutting KF, Rogers AA, Rippon MG. The importance of hydration in wound healing: reinvigorating the clinical perspective. J Wound Care 2016; 25:122, 124-30. [PMID: 26947692 DOI: 10.12968/jowc.2016.25.3.122] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.
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Affiliation(s)
- K Ousey
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
| | | | | | - M G Rippon
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
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32
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Ratliff CR, Yates S, McNichol L, Gray M. Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum. J Wound Ostomy Continence Nurs 2016; 43:347-64. [PMID: 27163774 PMCID: PMC4937809 DOI: 10.1097/won.0000000000000242] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.
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Affiliation(s)
- Catherine R. Ratliff
- Correspondence: Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, Box 801351, University of Virginia Health System, Charlottesville, VA 22908 ()
| | - Stephanie Yates
- Catherine R. Ratliff, PhD, RN, GNP-BC, CWOCN, CFCN, School of Nursing, University of Virginia Health System, Charlottesville
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Department of Advanced Clinical Practice, Duke University Medical Center, Durham, North Carolina
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine, Department of Urology, and School of Nursing, Department of Acute and Specialty Care, University of Virginia, Charlottesville
| | - Laurie McNichol
- Catherine R. Ratliff, PhD, RN, GNP-BC, CWOCN, CFCN, School of Nursing, University of Virginia Health System, Charlottesville
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Department of Advanced Clinical Practice, Duke University Medical Center, Durham, North Carolina
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine, Department of Urology, and School of Nursing, Department of Acute and Specialty Care, University of Virginia, Charlottesville
| | - Mikel Gray
- Catherine R. Ratliff, PhD, RN, GNP-BC, CWOCN, CFCN, School of Nursing, University of Virginia Health System, Charlottesville
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Department of Advanced Clinical Practice, Duke University Medical Center, Durham, North Carolina
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine, Department of Urology, and School of Nursing, Department of Acute and Specialty Care, University of Virginia, Charlottesville
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Rippon M, Ousey K, Cutting K. Wound healing and hyper-hydration: a counterintuitive model. J Wound Care 2016; 25:68, 70-5. [DOI: 10.12968/jowc.2016.25.2.68] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- M.G. Rippon
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
| | - K. Ousey
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
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Patchan MW, Chae JJ, Lee JD, Calderon-Colon X, Maranchi JP, McCally RL, Schein OD, Elisseeff JH, Trexler MM. Evaluation of the biocompatibility of regenerated cellulose hydrogels with high strength and transparency for ocular applications. J Biomater Appl 2015; 30:1049-59. [PMID: 26589295 DOI: 10.1177/0885328215616273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prompt emergency treatment for ocular injury, particularly in a battlefield setting, is essential to preserve vision, reduce pain, and prevent secondary infection. A bandage contact lens that could be applied in the field, at the time of injury, would protect the injured ocular surface until hospital treatment is available. Cellulose, a natural polymer, is widely used in biomedical applications including bandage materials. Hydrogels synthesized from different cellulose sources, such as plants, cotton, and bacteria, can have the optical transparency and mechanical strength of contact lenses, by tailoring synthesis parameters. Thus, we optimized the fabrication of cellulose-based hydrogels and evaluated their in vivo biocompatibility and related physical properties. Our data demonstrate that along with tailorable physical properties, our novel cellulose-based hydrogels could be made with contact lens geometry, exhibit no significant signs of material toxicity after 22 days of in vivo testing, and show significant promise for use as a corneal bandage immediately following ocular trauma.
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Affiliation(s)
- Marcia W Patchan
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory (JHU/APL), Laurel, Maryland, USA
| | - J Jeremy Chae
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Justin D Lee
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiomara Calderon-Colon
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory (JHU/APL), Laurel, Maryland, USA
| | - Jeffrey P Maranchi
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory (JHU/APL), Laurel, Maryland, USA
| | - Russell L McCally
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory (JHU/APL), Laurel, Maryland, USA Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jennifer H Elisseeff
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Morgana M Trexler
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory (JHU/APL), Laurel, Maryland, USA
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