Journal of wound care最新文献

{"title":"The impact of dual-enrolee (Medicare/Medicaid) status on venous leg ulcer outcomes: a retrospective study.","authors":"Naz Wahab, William H Tettelbach, Vickie Driver, Martha R Kelso, Julie L De Jong, Brandon Hubbs, R Allyn Forsyth, Alisha Oropallo","doi":"10.12968/jowc.2024.0174","DOIUrl":"https://doi.org/10.12968/jowc.2024.0174","url":null,"abstract":"<p><strong>Objective: </strong>To quantify race, sex, comorbidities, Medicaid status, and compare health outcomes for Medicare-only versus Medicare/Medicaid dual-enrolees who developed a hard-to-heal venous leg ulcer (VLU).</p><p><strong>Method: </strong>Medicare Limited Data Standard analytic hospital inpatient and outpatient department files were used to follow episodes of medical care for a VLU from 1 October 2015-2 October 2019. In an earlier study, patients diagnosed concurrently with chronic venous insufficiency and a VLU were propensity-matched. In this current work, cohorts were split into patients enrolled in Medicare-only and those enrolled in Medicare and Medicaid (dual-enrolees). Treatment methods were compared and the most commonly used cellular, acellular and matrix-like product (CAMP) among Medicare beneficiaries-dehydrated human amnion chorion membrane (DHACM)-was evaluated. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs and outcomes such as time to ulcer closure, rates of complications and hospital usage rates. Quality of life (QoL) metrics, such as pain and time to VLU closure, were compared across the groups.</p><p><strong>Results: </strong>Of the 555,284 Medicare beneficiaries evaluated in this analysis, 27% were Medicare/Medicaid dual-enrolees and 73% were Medicare-only enrolees. To qualify for Medicaid, patient income had to be ≤133% of the federal poverty level. Only 3% of Medicare-only patients and 6% of dual-enrolees had an Advantage plan, a lower rate than the general Medicare population. Dual-enrolees, compared to those covered by Medicare-only, demonstrated: a Charlson Comorbidity Index (CCI) score one point greater (p<0.0001); a higher percentage (16%) of patients from minority ethnic backgrounds; and significantly higher rates of emergency department visits (p<0.0001) and cellulitis (p=0.034). Dual-enrolees who received early and regularly applied CAMPs also reduced their treatment time by 21 days (p=0.0027), all of which can impact costs.</p><p><strong>Conclusion: </strong>The socioeconomic status of dual-enrolees included near poverty status, a higher percentage of patients from a minority ethnic background, and high rates of comorbidities compared to their Medicare-only counterparts. The VLUs of dual-enrolees took longer to close, developed more complications, and used significantly more hospital resources and expenses. Outcomes significantly improved when VLU episodes were treated with a CAMP, such as DHACM, while following parameters for use. Socioeconomic variables are associated with poor outcomes for patients with hard-to-heal (chronic) wounds. This should be tracked to find cost-effective interventions throughout their journey to provide equitable care and ensure they are not left behind. Greater access for dual-enrolees to CAMPs has the potential to improve clinical outcomes and patient QoL, while concomitantly reducing overall healthc","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"886-892"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wounds in a correctional facility in Malta: a point prevalence study.","authors":"Anthea Gabriele, Samantha Holloway, Corinne Scicluna Ward","doi":"10.12968/jowc.2023.0220","DOIUrl":"https://doi.org/10.12968/jowc.2023.0220","url":null,"abstract":"<p><p>Hard-to-heal (chronic) wounds are a challenge to wound care professionals, a burden to the health service and negatively impact affected individuals' quality of life. They also consume a great deal of healthcare resources globally and are found in all settings, including prisons. Therefore, the evaluation of wound care services is essential in order to develop an awareness of where improvement can be made. The main aim of this point prevalence study was to gather data on wounds, wound aetiology and wound management in a Maltese correctional facility. A secondary aim was to compare current practice with the best evidence-based practice and clinical practice guidelines, in order to provide a set of recommendations which can be implemented to improve the service. A retrospective study was carried out, auditing the medical records of people with justice involvement. The results of the audit reported a low prevalence of wounds. While practice met existing standards, for example, no unnecessary wound swab was taken, several shortcomings in wound management were noted. To improve adherence to the clinical guidelines in conjunction with improving the quality of the current service offered in the wound clinic, a number of short- and long-term clinical recommendations were proposed including: the incorporation of pain assessment tools and C-reactive protein blood testing for identifying infection; early referral to specialised care for individuals with diabetic foot ulcers, as well as the necessity for proficient personnel specialising in wound management training.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"934-940"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early results of an orthoplastic multidisciplinary approach to diabetic foot ulcer soft tissue reconstruction.","authors":"Coeway Boulder Thng, Keng Lin Wong, Allen Wei-Jiat Wong, Khong Yik Chew, Kimberley Leow, Leon Timothy Charles Alvis, Sum Leong, Farah Gillan Irani, Wenxian Png, Eric Wei Liang Cher, Zhongzheng Ma, Mardiana Binte Moksin, Merng Koon Wong, Pearlie Woon Woon Tan, Yee Onn Kok, Jiajun Feng","doi":"10.12968/jowc.2023.0008","DOIUrl":"https://doi.org/10.12968/jowc.2023.0008","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality. Improving wound healing via soft tissue reconstruction may be the key to improving clinical outcomes. Thus, the Diabetic Limb Salvage (DLS) service in Sengkang General Hospital, Singapore, was established to provide patients with a streamlined, one-stop, comprehensive service dedicated to DFU soft tissue reconstruction. The reconstruction was carried out using secondary closure, skin grafting, local flaps or free flaps, depending on the severity of the wound and patient suitability. This study aims to audit the early outcomes of the DLS service.</p><p><strong>Method: </strong>Patients with DFUs treated by the DLS service were compared with patients with DFUs treated prior to the launch of the DLS service (control). Outcomes including major and minor amputation rates, wound healing rate, mortality and DFU recurrence rates were analysed statistically.</p><p><strong>Results: </strong>A total of 103 patients took part in the study (50 in the DLS service cohort and 50 in the control cohort). There was no significant difference in demographics, comorbidities and wound profiles between the two cohorts. All (100%) patients in the DLS service cohort received soft tissue reconstruction versus only 13% in the control group. The DLS service cohort had a significantly higher healing rate (96% versus 68%, respectively), shorter healing duration (77±30 days versus 111±43 days, respectively), reduced major amputation rate (0% versus 9%, respectively), and reduced recurrence rate (6% versus 25%, respectively) compared with the control cohort within the one-year follow-up.</p><p><strong>Conclusion: </strong>The findings of this study showed that an orthoplastic multidisciplinary approach focused on DFU soft tissue reconstruction improved wound healing rates, shortened healing duration and, as a result, lowered amputation rates and reduced recurrence.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"926-932"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.","authors":"Olivia Julian, Slava Agafonoff, Paul M Glat","doi":"10.12968/jowc.2022.0199","DOIUrl":"10.12968/jowc.2022.0199","url":null,"abstract":"<p><strong>Objective: </strong>Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove.</p><p><strong>Method: </strong>A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient.</p><p><strong>Results: </strong>The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints.</p><p><strong>Conclusion: </strong>Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"893-897"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speaker profile and interview: Thomas Serena.","authors":"Thomas E Serena","doi":"10.12968/jowc.2024.0412","DOIUrl":"https://doi.org/10.12968/jowc.2024.0412","url":null,"abstract":"","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"974-975"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive hyperbaric oxygen therapy and negative pressure wound therapy for hard-to-heal wounds: a systematic review and meta-analysis.","authors":"Liehao Yang, Jiao Kong, Yunlong Xing, Lingfeng Pan, Caihong Li, Zhuoxia Wu, Mingxi Li, Lianbo Zhang","doi":"10.12968/jowc.2022.0213","DOIUrl":"10.12968/jowc.2022.0213","url":null,"abstract":"<p><strong>Objective: </strong>Negative pressure wound therapy (NPWT) and hyperbaric oxygen therapy (HBOT) have been widely used in the treatment of hard-to-heal (chronic) wounds, but there is still a lack of sufficient evidence for their combined use for the treatment of hard-to-heal wounds. This systematic review aimed to identify the clinical efficacy and safety of adding adjunctive HBOT to NPWT for hard-to-heal wounds.</p><p><strong>Method: </strong>Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang were searched from the establishment of the database to March 2022. The literature was screened according to the inclusion criteria and exclusion criteria. We assessed the quality of each included study with the Cochrane Collaboration Risk of Bias tool and Newcastle-Ottawa Scale. A meta-analysis was performed using R programming software version 4.1.0 (R Project for Statistical Computing, US). The PRISMA 2020 guidelines were used to report data from systematic reviews and meta-analysis.</p><p><strong>Results: </strong>A total of 15 studies were identified, including nine randomised clinical controlled trials and six retrospective studies. Meta-analysis results showed that NPWT combined with HBOT had better outcomes compared with the NPWT alone with regards to: wound healing rate (odds ratio (OR)=6.77; 95% confidence interval (Cl): 3.53-12.98; p<0.0001); bacterial positive rate of wound (OR=0.16; 95% CI: 0.05-0.55; p=0.0037); wound healing time (mean difference (MD)= -3.86; 95% Cl: -5.18 - -2.53; p<0.0001); wound area (standardised mean difference (SMD)=1.50; 95% Cl: 0.35-2.65; p=0.0104); hospitalisation time (MD= -3.14; 95% Cl: -4.93 - -1.36; p=0.005); and hospitalisation cost (OR= -202.64; 95% Cl: -404.53 - -0.75; p=0.0492). There was no significant difference in pain score (MD= -0.43; 95% Cl: -1.15-0.30; p=0.25).</p><p><strong>Conclusion: </strong>The findings of this study demonstrated that adjunctive HBOT with NPWT is safe and effective in the treatment of hard-to-heal wounds. However, these findings should be interpreted with great caution given the limitations of the studies included.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"950-957"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A continuous mode of action of nitric oxide in hard-to-heal wound healing.","authors":"David A Bell, C Michael Miller, Rhonda Sullivan","doi":"10.12968/jowc.2024.0004","DOIUrl":"https://doi.org/10.12968/jowc.2024.0004","url":null,"abstract":"<p><p>Nitric oxide (NO) is one of the most studied molecules in medical science. The role of NO as an endogenous regulator of inflammation, as an antibacterial agent and as an endogenous gasotransmitter is well established. Even so, despite a plethora of excellent wound healing data, hard-to-heal (chronic) wounds are of epidemic proportions, and still growing in number. However, yet to be established and sorely needed is the identification of a single, continuous NO mechanism of action (MoA), where phase-to-phase variance in the complex sequence of cellular and molecular wound healing may elucidate the potential for placing hard-to-heal wounds on positive healing trajectories. Hence, the objectives of this review were to: identify salient MoAs for NO in each phase of skin wound healing; and to select and validate a single MoA that is both ubiquitous and continuous in NO across acute and hard-to-heal wound sequences, and which potentiates the ability to supplementally motivate and guide the recovery of a hard-to-heal wound onto a positive healing trajectory. The search began by selecting a detailed, multipart wound healing model. Next, as guided by the literature, was the identification of salient NO functionalities for each model segment. These modes of action were then be used to identify and validate a single NO MoA that is continuous across the healing spectrum. Finally, by using the principle of 'super position' of two continuous functions, this acute healing NO MoA solution was compared to a similar solution set describing a hard-to-heal or chronic wound. As both solution sets are continuous in a NO function, the resultant 'overlay' then helped to identify and guide the use of a NO MoA capable of placing any hard-to-heal wound on a positive healing trajectory.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"912-925"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAMPs Summit 2025: reimagining possibilities in wound care.","authors":"Tracy Cowan","doi":"10.12968/jowc.2024.0411","DOIUrl":"https://doi.org/10.12968/jowc.2024.0411","url":null,"abstract":"","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"969"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxic epidermal necrolysis: management strategies in burns units.","authors":"Iker Miguel Escuredo, Laura Cabañas Weisz, Javier Vásquez Manau, Juan Bautista Ayestarán Soto, Jesus Gardeazabal García","doi":"10.12968/jowc.2021.0063","DOIUrl":"10.12968/jowc.2021.0063","url":null,"abstract":"<p><strong>Objective: </strong>The most common severe exfoliative condition is toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, for which patients may sometimes require admission to hospital burns units. This study analyses the experience of the authors and results in this condition at the Cruces University Hospital in Bilbao, Spain.</p><p><strong>Method: </strong>Over the last 22 years, the authors carried out a retrospective analytical observational study of TEN cases at the hospital and analysed risk factors including age, associated comorbidities, percentage of body surface area affected, positive bacterial culture, and treatment strategies used to assess their potential influence on prognosis.</p><p><strong>Results: </strong>The results indicated an association between mortality and age (ρ (rho)=0.60, 95% CI [0.29, 0.79], p<0,001), ocular (ρ=0.58, 95% CI [0.28, 0.78], p<0.001), oropharyngeal (ρ=0.64, 95% CI [0.36, 0.81], p<0.001), genitourinary (ρ=0.58 CI [0.28, 0.78], p<0.001) respiratory mucosa involvement (ρ=0.53, 95 % CI [0.28, 0.78], p<0.001) and bacteraemia (ρ=0.44, 95% CI [0.17, 0.64], p=0.020). Bacteraemia also showed a higher incidence in elderly patients (ρ=0.4, 95% CI [0.03, 0.67], p=0.033) and in those with a higher Score for Toxic Epidermal Necrolysis at admission (ρ=0.51, CI [0.17, 0.74], p=0.006). A reduction in mortality was found in patients who received systemic treatment; cyclosporine, etanercept or a combination of both (ρ=-0.44, Cl [-0.70, -0.09], p=0.018).</p><p><strong>Conclusion: </strong>TEN is a rare but serious exfoliative condition. Traditionally, management of denuded skin was seen as the main prognostic factor; yet, systemic damage, especially to the respiratory mucosa, significantly increases mortality risk. While life support is crucial and recovery is possible, preventing long-term sequelae relies on effective care protocols. Current treatments may offer benefits, though their efficacy remains unclear. Clinicians in burns units should develop standardised protocols and collaborate on long-term studies to enhance patient care.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"942-949"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speaker profile and interview: William Tettelbach.","authors":"William H Tettelbach","doi":"10.12968/jowc.2024.0413","DOIUrl":"https://doi.org/10.12968/jowc.2024.0413","url":null,"abstract":"","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"33 12","pages":"970-972"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}