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Smart H, Sibbald RG, Goodman L, Ayello EA, Jaimangal R, Gregory JH, Akita S, Alavi A, Armstrong DG, Arputhanathan H, Bruwer F, Caul J, Chan B, Cronje F, Dofitas B, Hamed J, Harley C, Heil J, Hill M, Jahnke D, Kalina D, Kodange C, Kotru B, Kozody LL, Landis S, LeBlanc K, MacDonald M, Mark T, Martin C, Mayer D, Murphy C, Nair H, Orellana C, Ostrow B, Queen D, Rainville P, Rajhathy E, Schultz G, Somayaji R, Stacey MC, Tariq G, Weir G, Whiteside C, Yifter H, Zacharias R. Wound Bed Preparation 2024: Delphi Consensus on Foot Ulcer Management in Resource-Limited Settings. Adv Skin Wound Care 2024; 37:180-196. [PMID: 38354304 DOI: 10.1097/asw.0000000000000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
GENERAL PURPOSE To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.
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Rajhathy EM, Hill MC, Tran DL, Huang RW, Chiu ES, Sibbald RG, Ayello EA. Debridement options for the interprofessional team. Nursing 2024; 54:30-38. [PMID: 38386448 DOI: 10.1097/01.nurse.0001006292.75909.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses the different normal tissue components that are critical to safe debridement practice, various methods of wound debridement for nurses, and the importance of an interprofessional team and consulting a wound specialist.
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Affiliation(s)
- Erin M Rajhathy
- Erin Rajhathy is a doctoral student at Örebro University, Örebro, Sweden. Mary Hill is an RN in Alberta, Canada. David Tran is a postdoctoral research fellow at the NYU Grossman School of Medicine. Ren-Wen Huang is an attending physician at Linkou Chang Gung Memorial Hospital in Taiwan. Ernest Chiu is a professor of plastic surgery at the NYU Grossman School of Medicine in New York, NY. Gary Sibbald is a professor of medicine and public health at the University of Toronto. Elizabeth Ayello is a faculty emeritus of Excelsior University School of Nursing in Albany, N.Y., and is a member of the Nursing2024 editorial board
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Geng RSQ, Bourkas AN, Mufti A, Sibbald RG. Rosacea: Pathogenesis and Therapeutic Correlates. J Cutan Med Surg 2024; 28:178-189. [PMID: 38450615 PMCID: PMC11015710 DOI: 10.1177/12034754241229365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Rosacea is a chronic inflammatory condition of which there is no cure. The pathogenesis of rosacea is likely multifactorial, involving genetic and environmental contributions. Current understanding suggests that pro-inflammatory pathways involving cathelicidins and inflammasome complexes are central to rosacea pathogenesis. Common rosacea triggers modulate these pathways in a complex manner, which may contribute to the varying severity and clinical presentations of rosacea. Established and emerging rosacea treatments may owe their efficacy to their ability to target different players in these pro-inflammatory pathways. Improving our molecular understanding of rosacea will guide the development of new therapies and the use of combination therapies.
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Affiliation(s)
- Ryan S. Q. Geng
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R. Gary Sibbald
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Sibbald RG, Dalgarno N, Hastings-Truelove A, Soleas E, Jaimangal R, Elliott J, Coderre-Ball AM, Hill S, van Wylick R, Smith K. COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp. Adv Skin Wound Care 2024; 37:76-84. [PMID: 38241450 DOI: 10.1097/asw.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.
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Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, FRCPC (Med, Derm), FAAD, MAPWCA, JM, is Professor of Public Health and Medicine, University of Toronto, Dalla Lana School of Public Health and Dept. of Medicine, Faculty of Medicine, University of Toronto, Canada. Nancy Dalgarno, HBOR, BEd, MEd, PhD, OCT, is Director of Education Scholarship, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Canada. Also at Queen's University, Amber Hastings-Truelove, MA, PhD, is Health Education Researcher and Consultant, Office of Professional Development and Educational Scholarship; and Eleftherios Soleas, MEd, PhD, OCT, is Director of Continuing Professional Development, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences. Reneeka Jaimangal, MD, MScCH, is Project Manager, WoundPedia Project ECHO Ontario, Ontario Skin and Wound, Mississauga, Canada. James Elliott, MSc, is Director of Operations, Woundpedia, Mississauga. Also at Queen's University, Angela M. Coderre-Ball, MSc, PhD, is Research Associate, Department of Family Medicine; Shannon Hill, MEd, OCT, is PhD Candidate, School of Rehabilitation Therapy; Richard van Wylick, MD, FRCPC, is Associate Dean, Professional Development, Faculty of Health Sciences; and Karen Smith, MD, FRCPC, FAAPMR, FABEM, is Professor, Department of Physical Medicine and Rehabilitation
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Geng R, Sibbald RG. Acne Vulgaris: Clinical Aspects and Treatments. Adv Skin Wound Care 2024; 37:67-75. [PMID: 38241449 DOI: 10.1097/asw.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
GENERAL PURPOSE To review the clinical presentation and treatment of acne vulgaris. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify a differential diagnosis of acne vulgaris.2. Recognize clinical feature of various acne vulgaris subtypes.3. Specify epidemiologic characteristics of acne vulgaris.4. Select topical, systemic, and nonpharmaceutical treatment options for a patient with acne vulgaris.
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Ayello EA, Sibbald RG. Virtual Wound Care Education and Learning. Adv Skin Wound Care 2024; 37:62. [PMID: 38241446 DOI: 10.1097/asw.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
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Geng R, Bourkas AN, Sibbald RG. Rosacea: Clinical Aspects and Treatments. Adv Skin Wound Care 2023; 36:626-634. [PMID: 37983575 DOI: 10.1097/asw.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
GENERAL PURPOSE To review the clinical presentation and treatment of rosacea. 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 the clinical manifestations of rosacea subtypes.2. Identify pharmacologic and nonpharmacologic treatment options for patients who have rosacea.
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Bourkas AN, Geng R, Sibbald M, Sibbald RG. A case of erythromelalgia with gastrointestinal dysautonomia treated with immunoglobulin: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231213137. [PMID: 38022850 PMCID: PMC10658769 DOI: 10.1177/2050313x231213137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
An 18-year-old female with a history of atopic march, hyperhidrosis, and eosinophilic esophagitis was diagnosed with erythromelalgia and gastrointestinal dysautonomia secondary to presumed autoimmune small fiber neuropathy. The patient experienced significant clinical improvements after the initiation of intravenous immunoglobulin therapy, supporting an underlying autoimmune disorder.
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Affiliation(s)
| | - Ryan Geng
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Sibbald
- Department of Medicine, McMaster Education Research Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - R Gary Sibbald
- Dalla Lana School of Public Health & Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Kim PJ, Abduelmula A, Mistry J, Mufti A, Sibbald RG. Characteristics and Outcomes of Squamous Cell Carcinoma and Other Cutaneous Malignancies in Epidermolysis Bullosa: A Systematic Review. Adv Skin Wound Care 2023; 36:486-494. [PMID: 37098819 DOI: 10.1097/01.asw.0000926608.29276.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To identify cases and summarize outcomes of cutaneous malignancies in patients with epidermolysis bullosa (EB). DATA SOURCES MEDLINE and EMBASE databases were searched on February 8, 2022. STUDY SELECTION Original observational or experimental studies with cases of cutaneous malignancy in patients with inherited EB were included. DATA EXTRACTION Data were extracted by two reviewers in duplicate. DATA SYNTHESIS A total of 87 articles with 367 patients were included in this systematic review. Squamous cell carcinomas were the most common malignancy (94.3%) with a median survival of 60 months. The presence of metastasis was investigated at diagnosis in 77 patients; 18.8% of patients had detectable metastasis. Patients with squamous cell carcinoma with metastasis at diagnosis had significantly shorter median survival (16.8 months) than those without (72 months; P = .027). The remission rate was 47.6%. At the end of follow-up, 15.1% were alive with disease, and 41.6% were deceased. Other malignancies included malignant melanoma and basal cell carcinoma. The most common initial modes of management were excisions (71.9%) and amputations (17.6%). Other modes included chemotherapy (4.6%), radiation (3.9%), and no treatment (2.6%). The overall rate of recurrence or new lesions was 38.8%, with a median time of 16 months to recurrence or new lesions. Immediate recurrence was lowest following amputation (4.3%). There were no statistically significant differences in median survival among initial excision, amputation, and all other modes combined ( P = .30). CONCLUSIONS Squamous cell carcinomas in patients with EB have a high likelihood of metastasis and mortality. Surgical excision is the most common intervention. There are no significant differences in survival among different initial management options. There is a need for research that documents and monitors outcomes of the treatment options.
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Affiliation(s)
- Patrick Jinhyung Kim
- In Ontario, Canada, Patrick Jinhyung Kim, BHSc, is Medical Student, Faculty of Medicine, McMaster University; Abrahim Abduelmula, BScN, is Medical Student, Faculty of Medicine, University of Western Ontario; Jenna Mistry, is Undergraduate Student, Faculty of Health Sciences, McMaster University; and Asfandyar Mufti, MD, is Resident, Division of Dermatology, Department of Medicine, University of Toronto. R. Gary Sibbald, MD, MEd, FAAD, FRCPC (Med Derm), MAPWCA, JM, is Professor of Medicine and Public Health; Director, International Interprofessional Wound Care Course and Master of Science in Community Health, Dalla Lana School of Public Health, University of Toronto; and Editor-in-Chief, Advances in Skin & Wound Care , Philadelphia, Pennsylvania, USA. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2022; accepted in revised form December 1, 2022. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Abstract
OBJECTIVE To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization." STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Sibbald RG, Ayello EA. Debridement: From Bloodletting to Selective Tissue Removal. Adv Skin Wound Care 2023; 36:175. [PMID: 36940372 DOI: 10.1097/01.asw.0000921100.42480.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Tran DL, Huang RW, Chiu ES, Rajhathy EM, Gregory JH, Ayello EA, Sibbald RG. Debridement: Technical Considerations and Treatment Options for the Interprofessional Team. Adv Skin Wound Care 2023; 36:180-187. [PMID: 36940374 DOI: 10.1097/01.asw.0000920660.07232.f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
GENERAL PURPOSE To enhance the learner's chronic wound debridement competence as an interprofessional team member. 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. Differentiate healable, maintenance, and nonhealable wounds to create a holistic debridement treatment plan using the Wound Bed Preparation paradigm.2. Evaluate active debridement options including the potential need for an interprofessional referral or specialized investigations.3. Assess chronic wound debridement options.4. Analyze case studies for appropriate clinical application of debridement modalities.
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Asiniwasis R, Stonechild AB, Queen D, Sibbald RG. Indigenous Diabetic Foot-Related Lower Extremity Amputations: Integrating Traditional Indigenous and Western Health Models for Improved Outcomes. Adv Skin Wound Care 2023; 36:63. [PMID: 36662036 DOI: 10.1097/01.asw.0000905664.97542.fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Sibbald RG, Hastings-Truelove A, DeJong P, Ayello EA. Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies. Adv Skin Wound Care 2023; 36:64-66. [PMID: 36662037 DOI: 10.1097/01.asw.0000904468.33764.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, FRCPC, FAAD, JM, is Professor, Division of Dermatology, Department of Medicine, and Dalla Lana School of Public Health, University of Toronto; Women's College Hospital, Toronto, Ontario, Canada; and co-Editor-in-Chief, Advances in Skin & Wound Care . At Queen's University, Kingston, Ontario, Amber Hastings-Truelove, PhD, is Health Education Researcher and Consultant, Professional Development and Educational Scholarship and Peggy DeJong, MD, MMEd, is Associate Professor of Cardiology. Elizabeth A. Ayello, PhD, MS, RN, CWON, FAAN, is co-Editor-in-Chief, Advances in Skin & Wound Care ; Faculty Emeritus, Excelsior College School of Nursing, Albany, New York; and President, Ayello Harris & Associates, Inc, Copake, New York. This article is considered expert opinion and was not subject to peer review
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Jicman PA, Smart H, Ayello EA, Sibbald RG. Early Malignant Melanoma Detection, Especially in Persons with Pigmented Skin. Adv Skin Wound Care 2023; 36:69-77. [PMID: 36662039 DOI: 10.1097/01.asw.0000911156.19843.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
GENERAL PURPOSE To present a comprehensive gap analysis of podiatric melanoma literature. 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. Select the appropriate assessment techniques for screening patients, especially those with skin of color, for melanoma.2. Compare and contrast the various types of melanoma.3. Discuss the results of the literature review that offer insight to clinicians screening patients for melanoma.
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; Publish Ahead of Print:00129334-990000000-00021. [PMID: 36705972 DOI: 10.1097/01.asw.0000919408.20614.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization. STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022
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Arputhanathan H, Hyde J, Atilola T, Queen D, Elliott J, Sibbald RG. A patient navigation model to improve complex wound care outcomes. Nurs Manag (Harrow) 2022; 53:31-41. [PMID: 36040731 DOI: 10.1097/01.numa.0000855956.26020.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Helen Arputhanathan
- At Home and Community Care Support Services in Waterloo, Wellington, Canada, Helen Arputhanathan , Jane Hyde , and Temidayo Atilola are RNs. Douglas Queen is a wound care business consultant and researcher for WoundPedia and ECHO Wound Program in Canada. James Elliott is a researcher and advocate for WoundPedia and ECHO Wound Program. R. Gary Sibbald is a professor of medicine and public health at the University of Toronto in Ontario, Canada
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Kashetsky N, Sachdeva M, Lu JD, Mufti A, Kim P, Bagit A, Sibbald RG. Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review. Adv Skin Wound Care 2022; 35:195-201. [PMID: 35311767 DOI: 10.1097/01.asw.0000822628.82131.1d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To present the results of a research study evaluating the diagnostic accuracy of the ankle-brachial pressure index (ABPI) compared with that of Doppler arterial waveforms (DAWs) to detect peripheral arterial disease (PAD). 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 completing this continuing education activity, the participant will:1. Summarize the evidence the authors considered when comparing the diagnostic accuracy of the ABPI with that of Doppler arterial waveforms to detect PAD.2. Select the characteristics of the participants in the studies the authors analyzed.3. Identify the results of the authors' study comparing the diagnostic accuracy of the ABPI with that of Doppler arterial waveforms to detect PAD.4. Distinguish the authors' conclusions about the advantages of using Doppler arterial waveforms to detect PAD.
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Kim PJ, Homsi HA, Sachdeva M, Mufti A, Sibbald RG. Chronic Wound Telemedicine Models Before and During the COVID-19 Pandemic: A Scoping Review. Adv Skin Wound Care 2022; 35:87-94. [PMID: 35050917 DOI: 10.1097/01.asw.0000805140.58799.aa] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GENERAL PURPOSE To present the results of a scoping review exploring chronic wound care telemedicine before and during the pandemic, including the characteristics of the models implemented. 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. Identify the characteristics of the studies the authors examined for their scoping review of chronic wound care telemedicine.2. Choose the electronic methods commonly used for wound care telemedicine in the studies the authors examined.3. Recognize the implications for the patients who participated in chronic wound care telemedicine in the studies the authors examined. ABSTRACT OBJECTIVETo explore different chronic wound telemedicine models and identify current research on this topic.METHODSThe authors searched the MEDLINE and EMBASE databases on August 10, 2021 and identified 58 articles included in the analysis.RESULTSIncluded studies were published between 1999 and 2021, with more than half of the studies published between 2015 to 2019 (25.9%, n = 15/58) and 2020 to 2021 (25.9%, n = 15/58). There were 57 models identified, of which 87.7% (n = 50/57) used a blended model of care. Image assessment was the most common element in blended care (66.0%, n = 33/50), followed by video consultation (46.0%, n = 23/50), text (44.0%, n = 22/50), and telephone consultation (22.0%, n = 11/50). Purely virtual care was used in 12.3% (n = 7/57) of models, 85.7% (n = 6/7) of which were implemented during the COVID-19 pandemic. Most studies conducted a quantitative analysis (62.1%, n = 36/58); 20.7% (n = 12/58) conducted a qualitative analysis, and 17.2% (n = 10/58) conducted both. The most frequently assessed results were wound outcomes (53.4%, n = 31/58) and patient opinions (25.9%, n = 15/58).CONCLUSIONSChronic wound care-related telemedicine has common elements: image assessment, video and telephone consultation, and text-based information that can be combined in a variety of ways with unique implementation barriers. Blended care models are more common than purely virtual alternatives. Heterogeneity among outcomes and reporting methods make the results difficult to synthesize.
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Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, BSc, FRCPC (Med Derm), MACP, FAAD, MAPWCA, DSc (Hons), is Professor of Public Health and Medicine, University of Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana School of Public Health, University of Toronto; Past President, Chair Education Committee, World Union of Wound Healing Societies; and Editor-in-Chief, Advances in Skin & Wound Care . Asfandyar Mufti, MD, BMSc, is Dermatology Resident, Faculty of Medicine, University of Toronto. David G. Armstrong, MD, PhD, DPM, is Professor of Surgery, University of Arizona College of Medicine, Tucson; and Director, Southern Arizona Limb Salvage Alliance. Hiske Smart, MA (Nur), RN, PGDipWHTR (UK), IIWCC, is Manager, Wound Care & Hyperbaric Oxygen Therapy Unit, King Hamad University Hospital, Kingdom of Bahrain
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Affiliation(s)
- Asfandyar Mufti
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Gary Sibbald
- Department of Dermatology, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Investigator, Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
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22
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Sibbald RG, Ayello EA. Psychophysiology: Connecting Skin, Wounds, Aging, and Depression. Adv Skin Wound Care 2021; 34:399. [PMID: 34260416 DOI: 10.1097/01.asw.0000758600.40793.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ayello EA, Sibbald RG. Clinical Observation and Data to Advance COVID-19 Knowledge. Adv Skin Wound Care 2021; 34:343. [PMID: 34125722 DOI: 10.1097/01.asw.0000753184.42091.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Gary Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ayello EA, Sibbald RG. May Hope Bloom and Grow. Adv Skin Wound Care 2021; 34:231. [PMID: 33852457 DOI: 10.1097/01.asw.0000742300.86108.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Mufti A, Sachdeva M, Maliyar K, Lansang RP, Lytvyn Y, Sibbald RG, Yeung J. Treatment outcomes in confluent and reticulated papillomatosis: A systematic review. J Am Acad Dermatol 2020; 84:825-829. [PMID: 33187737 DOI: 10.1016/j.jaad.2020.08.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Yuliya Lytvyn
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - R Gary Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto; Institute for Better Health, Trillium Health Partners; Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.
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Affiliation(s)
- Linda Laskowski-Jones
- EDITOR-IN-CHIEF, NURSING2019 Elizabeth A. Ayello is the co-Editor-in-Chief of Advances in Skin & Wound Care; Faculty, Excelsior College School of Nursing, Albany, New York; President, World Council of Enterostomal Therapists, President, Ayello Harris & Associates, Inc., Copake, New York; President (1999), National Pressure Ulcer Advisory Panel; and a member of the Nursing2019 Editorial Board. R. Gary Sibbald is the co-Editor-in-Chief of Advances in Skin & Wound Care; Professor, Medicine and Public Health, University of Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana Faculty of Public Health, University of Toronto; and President (2008-2012), World Union of Wound Healing Societies
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Ayello EA, Levine JM, Langemo D, Kennedy-Evans KL, Brennan MR, Gary Sibbald R. Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries. Adv Skin Wound Care 2019; 32:109-121. [DOI: 10.1097/01.asw.0000553112.55505.5f] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Cutaneous and other vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the body including the skin. Vasculitis has been traditionally divided according to the size of the vessel involved (small, medium, and large). Vasculitis is more of a reaction pattern rather than a specific disease entity. Therefore, the clinical presentation of vasculitis (most commonly palpable purpura on the lower extremities) dictates a thorough history, review of systems, and a meticulous physical examination. The diagnosis of vasculitis relies also on the histopathological and immunofluorescence studies. Wound care specialist may face with vasculitis-associated ulcers along with a spectrum of other cutaneous presentations associated with vasculitis. The focus of this article is to update the types, etiology, pathogenesis, and management options for cutaneous vasculitis.
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Affiliation(s)
- Eran Shavit
- 1 Women's College Hospital, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Alavi
- 1 Women's College Hospital, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | - R Gary Sibbald
- 1 Women's College Hospital, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
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Shavit E, Alavi A, Limacher JJ, Sibbald RG. Angiosarcoma complicating lower leg elephantiasis in a male patient: An unusual clinical complication, case report and literature review. SAGE Open Med Case Rep 2018; 6:2050313X18796343. [PMID: 30397474 PMCID: PMC6207953 DOI: 10.1177/2050313x18796343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Chronic lymphedema is rarely complicated by an angiosarcoma. Angiosarcoma superimposed on chronic lymphedema (Stewart-Treves syndrome) is usually seen post breast cancer surgery accompanied by lymph node resection of the axilla. This is a case report of a 59-year-old male patient with elephantiasis that developed an angiosarcoma of the lower leg. He died a month after the diagnostic biopsy was obtained. This is a rare multifocal tumor in a male with an unusual lower leg location. We reviewed the literature and the need to differentiate this often deadly lesion from a Kaposi's sarcoma.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - James J Limacher
- Division of Dermatology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - R Gary Sibbald
- Division of Dermatology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
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Alavi A, Sibbald RG, Kirsner RS. Optimal hidradenitis suppurativa topical treatment and wound care management: a revised algorithm. J DERMATOL TREAT 2017; 29:383-384. [DOI: 10.1080/09546634.2017.1385719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Afsaneh Alavi
- Women’s College Hospital, University of Toronto, Ontario, Canada
| | - R. Gary Sibbald
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Abstract
BACKGROUND Acitretin has been used for the treatment of severe psoriasis for over 20 years. OBJECTIVE The current project was conceived to optimise patient care by recognising the role acitretin can play in the treatment of patients with psoriasis and those with other disorders of keratinisation. METHODS A literature review was conducted to explore the role of acitretin and to assess its value for dermatologic disorders other than severe psoriasis. A panel of Canadian dermatologists developed a clinical pathway using a case-based approach, focusing on specific patient features. RESULTS The clinical pathway covers plaque psoriasis with hyperkeratotic plantar disease, palmoplantar pustulosis, hyperkeratotic hand dermatitis, lichen planus, lamellar ichthyosis, and hidradenitis suppurativa. CONCLUSION The recommendations in our clinical pathway reflect the current use of acitretin in Canada for severe psoriasis and other disorders of keratinisation.
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Affiliation(s)
- Lyn C Guenther
- 1 Guenther Research Inc., London, ON, Canada.,2 Western University, London, ON, Canada
| | - Rod Kunynetz
- 3 Ultranova Clinical Trials and Probity Medical Research, Barrie, ON, Canada
| | - Charles W Lynde
- 4 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Gary Sibbald
- 5 Della Lana Faculty of Public health and Faculty of Medicine, University of Toronto, Mississauga, ON, Canada.,6 University of Manitoba, Winnipeg, MB, Canada
| | - John Toole
- 6 University of Manitoba, Winnipeg, MB, Canada
| | - Ronald Vender
- 7 Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,8 Dermatrials Research & Venderm Innovations in Psoriasis. Hamilton, ON, Canada
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Abstract
GENERAL PURPOSE To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. 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. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. ABSTRACT Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.
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Affiliation(s)
- Elizabeth A Ayello
- Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN • Faculty • Excelsior College School of Nursing • Albany, New York • Senior Advisor • Hartford Institute for Geriatric Nursing • New York, New York • Course Director • IIWCC-New York University • New York, New York • President • Ayello, Harris and Associates, Inc, • Copake, New York • Clinical Editor, Advances in Skin & Wound Care • Philadelphia, Pennsylvania Karen Zulkowski, DNS, RN • Executive Editor • WCET Journal • Associate Professor (ret) • Montana State University • Bozeman, Montana Elizabeth Capezuti, PhD, RN, FAAN • Hearst Chair • Gerontology • Hunter-Bellevue School of Nursing • Hunter College of the City University of New York • New York Wendy Harris Jicman, BSN, BSHS, RN • Staff Nurse • Temple University Medical Center • Philadelphia, Pennsylvania R. Gary Sibbald, MD, FRCPC (Med, Derm), MACP, FAAD, Med, MAPWCA • Faculty • School of Public Health Sciences and Faculty of Medicine • University of Toronto • Ontario, Canada • Director • International Interprofessional Wound Care Course and Masters of Science in Community Health • Dalla Lana School of Public Health • University of Toronto • Toronto, Ontario, Canada • Clinical Editor, Advances in Skin & Wound Care • Philadelphia, Pennsylvania
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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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Abstract
The aim of this study was to determine the prevalence of malignant leg ulcers and to identify the most frequent characteristics of such wounds. This study was a retrospective investigation of patients with chronic leg ulcers in a North American tertiary wound clinic. Between January 2011 and September 2013, a total of 1189 patients with lower extremity wounds, including 726 patients with leg wounds, were identified. A total of 124 of the 726 had undergone a biopsy of their atypical wound, 16.1% (20/124) of which were malignant. Patients with malignant wounds were older than patients with nonmalignant leg wounds (P < .0001), and the common location of the malignant wound was the anterior shin (odds ratio = 3.5). The limitation of this analysis is the lack of distinction between malignant transformation of wounds and de novo presentation of malignancies as chronic nonhealing wounds. Three distinguishing morphological features in malignant wounds were irregular borders (P = .0002), presence of hypergranulation tissue (P < .0001), and friable/bleeding wound surface (P < .0001). The frequency of malignant wounds in patients with chronic leg ulcers highlights the need for a systematic approach, which would involve biopsy of wounds to identify malignancy in this patient population early on.
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Affiliation(s)
| | - Niloofar Anooshirvani
- Mount Sinai St. Luke's- Mount Sinai West Hospital, Icahn School of Medicine, United States
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Alavi A, Adam DN, Alhusayen R, Boucier M, Brassard A, Coutts P, Gooderham M, Gulliver W, Hong CH, Lynde C, Marcoux D, Papp K, Poulin Y, Sibbald RG, Shear NH. Definition of Moderate to Severe Hidradenitis Suppurativa: A Position Paper by the Canadian Hidradenitis Suppurativa Foundation (CHSF). J Cutan Med Surg 2016; 20:613-615. [PMID: 27821541 DOI: 10.1177/1203475416660296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
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Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What's new: Management of venous leg ulcers: Approach to venous leg ulcers. J Am Acad Dermatol 2016; 74:627-40; quiz 641-2. [PMID: 26979354 DOI: 10.1016/j.jaad.2014.10.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 12/31/2022]
Abstract
Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.
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Affiliation(s)
- Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada.
| | - R Gary Sibbald
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Department of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - O Fred Miller
- Department of Dermatology, Geisinger Health System, Danville, Pennsylvania
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - William Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Kevin Woo
- Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
| | | | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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Smith-Pliego M, Contreras-Ruiz J, Ryan S, Sibbald RG, Hanna W, Roldan-Marin R. Cutaneous malakoplakia masquerading as pyoderma gangrenosum. Int Wound J 2016; 14:658-660. [PMID: 27524799 DOI: 10.1111/iwj.12661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022] Open
Abstract
Cutaneous malakoplakia is a rare infection-related granulomatous disease frequently associated with immunocompromised states. Foamy macrophages containing basophilic granules, called the Michaelis-Gutman bodies, are pathognomonic. We report a case of cutaneous malakoplakia in a 77-year-old male with pyoderma gangrenosum and a 2-year history of a non-healing malleolar ulcer treated successfully with cotrimoxazole.
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Affiliation(s)
- Mariam Smith-Pliego
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Jose Contreras-Ruiz
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Siobhan Ryan
- International Interdisciplinary Wound and Ostomy Care Center, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - R Gary Sibbald
- International Interdisciplinary Wound and Ostomy Care Center, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - Wedad Hanna
- Department of Pathology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - Rodrigo Roldan-Marin
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Krishnamoorthy L, Harding K, Griffiths D, Moore K, Leaper D, Poskitt K, Sibbald RG, Brassard A, Dolynchuk K, Adams J, Whyman M. The clinical and histological effects of Dermagraft® in the healing of chronic venous leg ulcers. Phlebology 2016. [DOI: 10.1258/026835503321236858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Pilot study to assess the safety and effectiveness of Dermagraft® when used in conjunction with multi-layer compression bandage therapy (Profore™) compared with multilayer compression only in the treatment of chronic venous leg ulcers. Design: Open-label, prospective, multicentre, randomized, controlled clinical trial. Methods: Patients aged at least 18 years with leg ulceration of venous aetiology were screened for inclusion in the trial. Patients with arterial disease (ankle brachial pressure index <0.7) and causes of ulceration other than venous disease were excluded. Patients were randomized into four groups. Three active treatment groups received Dermagraft® in combination with compression bandaging, Profore™: Group 1, 12 pieces of Dermagraft (one per week for 12 weeks); Group 2, four pieces of Dermagraft (Weeks 0, 1, 4, 8); Group 3, one piece of Dermagraft (Week 0). The control group was treated with compression bandaging alone (Group 4). The study was not powered to detect statistical differences in healing rates. Adverse events were reported according to national guidelines. There was no statistical analysis of adverse event data. Results: In all 53 patients were randomized, of whom 47 completed the study per protocol. At 12 weeks complete healing of the ulcer, analysed by 'intention-to-treat' (ITT) was 15% using Profore alone, 7% using single application Dermagraft and Profore (Group 3), compared with 38% using multiple applications of Dermagraft and Profore (Groups 1 and 2). At study discontinuation, the median percentage reduction in wound area was 81.4% for Group 1, 88.6% for Group 2, 59.4% for Group 3 and 78.1% for Group 4. No major safety issues were identified during the course of the study. Conclusions: The results of the pilot study indicate that four pieces of Dermagraft are the optimal application frequency to take forward to further clinical trials. Further studies are required to confirm these data, and these should be powered to detect whether there are statistical differences in healing rates and safety between different regimens.
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Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C. Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg 2016; 20:432-45. [PMID: 27207355 DOI: 10.1177/1203475416650427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations.
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Affiliation(s)
- Yuka Asai
- Division of Dermatology, Queen's University, Kingston, ON, Canada
| | - Jerry Tan
- University of Western Ontario, Windsor, ON, Canada
| | | | | | | | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Danielle Marcoux
- CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Jason K Rivers
- Bearing Biomedical Consulting, Vancouver, BC, Canada Pacific DermAesthetics, Vancouver, BC, Canada
| | - Mariusz Sapijaszko
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - John Toole
- University of Manitoba, Winnipeg, MB, Canada
| | - Marcie Ulmer
- Bearing Biomedical Consulting, Vancouver, BC, Canada Carruthers & Humphrey, Vancouver, BC, Canada
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Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What's new: Management of venous leg ulcers. J Am Acad Dermatol 2016; 74:643-64; quiz 665-6. [DOI: 10.1016/j.jaad.2015.03.059] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/28/2015] [Accepted: 03/30/2015] [Indexed: 12/31/2022]
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43
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Mehdizadeh A, Hazen PG, Bechara FG, Zwingerman N, Moazenzadeh M, Bashash M, Sibbald RG, Alavi A. Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis. J Am Acad Dermatol 2016; 73:S70-7. [PMID: 26470621 DOI: 10.1016/j.jaad.2015.07.044] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/16/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. OBJECTIVE This study provides a comprehensive systematic review of surgical approaches in the management of HS. METHODS A systematic literature search and meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. LIMITATIONS There was poor quality evidence and potential improper reporting of the results. CONCLUSION This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions.
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Affiliation(s)
- Ali Mehdizadeh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul G Hazen
- Case Western Reserve University, Cleveland, Ohio
| | | | - Nora Zwingerman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Morteza Bashash
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Gary Sibbald
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada.
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Sibbald RG, Mufti A. Hidradenitis suppurativa. CMAJ 2015; 187:1235. [PMID: 26261194 DOI: 10.1503/cmaj.150018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- R Gary Sibbald
- Division of Dermatology (Sibbald), Dalla Lana School of Public Health, Department of Medicine, Faculty of Medicine and Faculty of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Mufti) University of Ottawa, Ottawa, Ont.
| | - Asfandyar Mufti
- Division of Dermatology (Sibbald), Dalla Lana School of Public Health, Department of Medicine, Faculty of Medicine and Faculty of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Mufti) University of Ottawa, Ottawa, Ont
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Kim WB, Sibbald RG, Hu H, Bashash M, Anooshirvani N, Coutts P, Alavi A. Clinical Features and Patient Outcomes of Hidradenitis Suppurativa. J Cutan Med Surg 2015; 20:52-7. [DOI: 10.1177/1203475415602840] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Despite the high burden of disease associated with hidradenitis suppurativa (HS), epidemiologic data are scarce. Objective: The objective was to review demographic features and clinical findings in 80 HS patients from 2 referral centres in Ontario, Canada, from October 2013 to September 2014, and to assess for factors that are associated with more advanced disease. Methods: Multicentre cross-sectional study. The data on demographic and clinical features were obtained by questionnaires and chart review. Results: Of a total of 80 patients (67.5% females), percentages of patients in Hurley stages I, II, and III were 15.4%, 55.8%, and 28.9%, respectively. Most patients were not diagnosed for more than 1 year (70.1%). Patients with more severe disease were more likely to be females and to have a greater number of lesions and were less likely to be diagnosed initially by a dermatologist. Conclusions: This study documents the common demographic and clinical features of HS to optimize resource allocation and patient outcomes.
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Affiliation(s)
- Whan B. Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - R. Gary Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Wound Healing Clinic, Mississauga, ON, Canada
| | - Howard Hu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Morteza Bashash
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
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Woodbury MG, Sibbald RG, Ostrow B, Persaud R, Lowe JM. Tool for Rapid & Easy Identification of High Risk Diabetic Foot: Validation & Clinical Pilot of the Simplified 60 Second Diabetic Foot Screening Tool. PLoS One 2015; 10:e0125578. [PMID: 26121258 PMCID: PMC4486169 DOI: 10.1371/journal.pone.0125578] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/25/2015] [Indexed: 12/30/2022] Open
Abstract
Background Most diabetic foot amputations are caused by ulcers on the skin of the foot i.e. diabetic foot ulcers. Early identification of patients at high risk for diabetic foot ulcers is crucial. The ‘Simplified 60-Second Diabetic Foot Screening Tool’ has been designed to rapidly detect high risk diabetic feet, allowing for timely identification and referral of patients needing treatment. This study aimed to determine the clinical performance and inter-rater reliability of ‘Simplified 60 Second Diabetic Foot Screening Tool’ in order to evaluate its applicability for routine screening. Methods and Findings The tool was independently tested by n=12 assessors with n=18 Guyanese patients with diabetes. Inter-rater reliability was assessed by calculating Cronbach’s alpha for each of the assessment items. A minimum value of 0.60 was considered acceptable. Reliability scores of the screening tool assessment items were: ‘monofilament test’ 0.98; ‘active ulcer’ 0.97; ‘previous amputation’ 0.97; ‘previous ulcer’ 0.97; ‘fixed ankle’ 0.91; ‘deformity’ 0.87; ‘callus’ 0.87; ‘absent pulses’ 0.87; ‘fixed toe’ 0.80; ‘blisters’ 0.77; ‘ingrown nail’ 0.72; and ‘fissures’ 0.55. The item ‘stiffness in the toe or ankle’ was removed as it was observed in only 1.3% of patients. The item ‘fissures’ was also removed due to low inter-rater reliability. Clinical performance was assessed via a pilot study utilizing the screening tool on n=1,266 patients in an acute care setting in Georgetown, Guyana. In total, 48% of patients either had existing diabetic foot ulcers or were found to be at high risk for developing ulcers. Conclusions Clinicians in low and middle income countries such as Guyana can use the Simplified 60-Second Diabetic Screening Tool to facilitate early detection and appropriate treatment of diabetic foot ulcers. Implementation of this screening tool has the potential to decrease diabetes related disability and mortality.
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Lowe J, Sibbald RG, Taha NY, Lebovic G, Rambaran M, Martin C, Bhoj I, Ostrow B. The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country. Int J Endocrinol 2015; 2015:920124. [PMID: 26089901 PMCID: PMC4452302 DOI: 10.1155/2015/920124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P < 0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.
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Affiliation(s)
- Julia Lowe
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - R. Gary Sibbald
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Nashwah Y. Taha
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Gerald Lebovic
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Madan Rambaran
- Institute of Health Science Education, University of Guyana, Georgetown, Guyana
| | - Carlos Martin
- Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Indira Bhoj
- Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Brian Ostrow
- Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5
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Alavi A, Sibbald RG, Mayer D. Reply to letter to editor: Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease. Vascular 2015; 23:445-6. [PMID: 25957342 DOI: 10.1177/1708538115584727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Canada
| | - R Gary Sibbald
- Department of Medicine (Dermatology) and Public Health, University of Toronto, Canada
| | - Dieter Mayer
- Department of Vascular Surgery, University Hospital of Zurich, Switzerland
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Gupta AK, Sibbald RG, Andriessen A, Belley R, Boroditsky A, Botros M, Chelin R, Gulliver W, Keast D, Raman M. Toenail Onychomycosis—A Canadian Approach With a New Transungual Treatment. J Cutan Med Surg 2015; 19:440-9. [DOI: 10.1177/1203475415581310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. Objective: To define a patient-centred Canadian treatment strategy for onychomycosis. Methods: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. Results: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. Conclusion: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.
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Affiliation(s)
- Aditya K. Gupta
- University of Toronto, Toronto, ON, Canada, & Mediprobe Research Inc, London, ON, Canada
| | | | | | - Richard Belley
- Département de Médecine Familiale et, Médecine d’urgence, Faculté de Médecine de l’Université Laval, Québec, QC, Canada
| | | | | | | | - Wayne Gulliver
- Faculty of Medicine, Memorial University, St John, NF, Canada
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50
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Lowe J, Sibbald RG, Taha NY, Lebovic G, Martin C, Bhoj I, Kirton R, Ostrow B. The Guyana Diabetes and Foot Care Project: a complex quality improvement intervention to decrease diabetes-related major lower extremity amputations and improve diabetes care in a lower-middle-income country. PLoS Med 2015; 12:e1001814. [PMID: 25898312 PMCID: PMC4405371 DOI: 10.1371/journal.pmed.1001814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Julia Lowe and colleagues describe the Guyana Diabetes Foot Care Project, a quality improvement intervention for improving diabetes care in a low-income setting.
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Affiliation(s)
- Julia Lowe
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - R. Gary Sibbald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nashwah Y. Taha
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre (AHRC), St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada
| | - Carlos Martin
- Georgetown Public Hospital Corporation, Ministry of Health Guyana, Georgetown, Guyana
| | - Indira Bhoj
- Georgetown Public Hospital Corporation, Ministry of Health Guyana, Georgetown, Guyana
| | - Rolinda Kirton
- Guyana Diabetes and Foot Care Project, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Brian Ostrow
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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