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Gillette B, Criscitelli T, Howell R, Woods J, Acerra M, Gorenstein S. Regenerative Wound Surgery: Practical Application of Regenerative Medicine in the OR. AORN J 2020; 109:298-317. [PMID: 30811562 DOI: 10.1002/aorn.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic nonhealing wounds cause significant morbidity and mortality and remain a challenging condition to treat. Regenerative wound surgery involves operative debridement of wounds to remove dead and healing-impaired tissue and bacterial contamination and, subsequently, the application of regenerative medicine treatments to accelerate healing. Regenerative treatments aim to restore native tissue structure and function by targeting biological mechanisms underlying impaired healing. A wide range of regenerative modalities are used for treating chronic and complex wounds, including decellularized scaffolds, living engineered donor tissues, autologous stem cells, and recombinant growth factors. Each of these modalities has specific and sometimes complex requirements for implementation. The advanced wound care team, including OR staff members, should be aware of how these products are used and regulated. This article highlights some of the common and emerging regenerative treatments that are applied in wound surgery and focuses on how the products are used practically in the OR.
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Abstract
Care for patients with chronic wounds can be complex, and the chances of poor outcomes are high if wound care is not optimized through evidence-based protocols. Tracking and managing every variable and comorbidity in patients with wounds is difficult despite the increasing use of wound-specific electronic medical records. Harnessing the power of big data analytics to help nurses and physicians provide optimized care based on the care provided to millions of patients can result in better outcomes. Numerous applications of machine learning toward workflow improvements, inpatient monitoring, outpatient communication, and hospital operations can improve overall efficiency and efficacy of care delivery in and out of the hospital, while reducing adverse events and complications. This article provides an overview of the application of big data analytics and machine learning in health care, highlights important recent advances, and discusses how these technologies may revolutionize advanced wound care.
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Zhang X, Modayil R, Criscitelli T, Stavropoulos SN. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol 2019; 4:39. [PMID: 31231706 DOI: 10.21037/tgh.2019.05.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) are the frontier of therapeutic endoscopic. These two methods rely on the skillset and equipment of endoscopic submucosal dissection (ESD) while going beyond the boundaries of the gastrointestinal lumen. They are both representatives of natural orifice transluminal endoscopic surgery, with STER being a direct off-shoot of peroral endoscopic myotomy (POEM). Both techniques are designed for the removal of gastrointestinal tumors originating from the muscularis propria but tend to be used in different organs and come with respective challenges. In this review we will go over the history, indication, technique and literature of these two techniques.
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Affiliation(s)
- Xiaocen Zhang
- Mount Sinai St. Luke's-West Hospital Center, New York, NY, USA
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Brem H, Howell R, Criscitelli T, Senderowicz A, Siegart N, Gorenstein S, Gillette B. Practical Application of Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) in Patients with Wounds. Surg Technol Int 2018; 32:61-66. [PMID: 29611156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rapidly evolving advances in wound-care technologies and treatment modalities, including locally injectable granulocyte-macrophage colony-stimulating factor (GM-CSF), are increasingly being used. Based on its role in the stimulation and recruitment of key contributors to wound healing, such as keratinocytes, macrophages, and fibroblasts, GM-CSF is considered to play an essential role in the wound-healing cascade. Synthetic GM-CSF has been shown to have a positive effect on the healing of chronic wounds when given as a local injection in a small number of patients. Subsequent randomized, controlled trials demonstrated that GM-CSF accelerated the healing of chronic wounds. This paper reviews the proposed mechanism of action of GM-CSF in wound healing. We also describe its method of application in the operating room at a tertiary care center for patients with wounds. Key Messages: Many types of chronic wounds have an altered keratinocyte and macrophage function that can be potentially assuaged by the addition of locally injected growth factor therapy to standard-of-care treatment. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been shown to be beneficial for the treatment of chronic, non-healing wounds. This article reviews the data on GM-CSF, reports a proposed mechanism of action, and describes its use by a team of wound surgeons.
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Affiliation(s)
- Harold Brem
- Division of Wound Healing and Regenerative Medicine, Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ
| | | | | | | | | | - Scott Gorenstein
- Division of Regenerative Medicine, NYU Winthrop Hospital, Mineola, NY
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Howell RS, Criscitelli T, Woods JS, Gillette BM, Brem H, Gorenstein S. A Perioperative Approach to Increase Limb Salvage When Treating Foot Ulcers in Patients With Diabetes. AORN J 2018; 107:431-440. [PMID: 29595900 DOI: 10.1002/aorn.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Foot ulceration in patients with diabetes increases the risk of lower extremity amputation. Major amputations produce substantial adverse consequences, increase length of hospital stay, diminish quality of life, and increase mortality. In this article, we describe approaches that decrease amputations and improve the quality of life for patients with diabetes and foot ulcers. We highlight the role of the perioperative nurse, who is essential to providing optimal patient care in the perioperative period. Perioperative care of patients with diabetes involves providing optimal surveillance for a break in the skin of the foot, screening for neuropathy, following guidelines for foot ulcer infections, preparing for pathophysiology-based debridement, using adjuvant therapies, and offloading the patient's affected foot. Nurses should understand the disease process and pathophysiology and how to use these approaches in the perioperative setting to assist in curtailing the morbidity and mortality associated with foot ulcers in patients with diabetes.
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Howell RS, Criscitelli T, Woods JS, Gillette BM, Gorenstein S. Hyperbaric Oxygen Therapy: Indications, Contraindications, and Use at a Tertiary Care Center. AORN J 2018; 107:442-453. [DOI: 10.1002/aorn.12097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Howell RS, Gorenstein S, Castellano M, Slone E, Woods JS, Gillette BM, Donovan V, Criscitelli T, Brem H, Brathwaite C. Wound Care Center of Excellence: Guide to Operative Technique for Chronic Wounds. J Am Coll Surg 2017; 226:e7-e17. [PMID: 29154922 DOI: 10.1016/j.jamcollsurg.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Eric Slone
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
| | - Jon S Woods
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
| | | | | | | | - Harold Brem
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY.
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Criscitelli T. Improving Efficiency and Patient Experiences: The Perioperative Surgical Home Model. AORN J 2017; 106:249-253. [DOI: 10.1016/j.aorn.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/18/2017] [Indexed: 01/17/2023]
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Criscitelli T, Goodwin W. Applying Human-Centered Design Thinking to Enhance Safety in the OR. AORN J 2017; 105:408-412. [DOI: 10.1016/j.aorn.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022]
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Criscitelli T. Caring for Patients With Chronic Wounds: Safety Considerations During the Surgical Experience. AORN J 2016; 104:67-70. [DOI: 10.1016/j.aorn.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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Criscitelli T. Alarm Management: Promoting Safety and Establishing Guidelines. AORN J 2016; 103:518-21. [DOI: 10.1016/j.aorn.2016.03.008] [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] [Received: 01/07/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
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Criscitelli T. The SAGES Manual on the Fundamental Use of Surgical Energy (FUSE). AORN J 2013. [DOI: 10.1016/j.aorn.2012.12.004] [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: 10/27/2022]
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