Wound Assessment Research Articles

A Comparative Study of the Incidence and Severity of Surgical Site Infection Following Emergency and Elective Abdominal Surgeries in a Tertiary Care Hospital

Background: Surgical site infection is a medical condition that develops up to 30 days after the surgery if no implants have been placed, and as long as 12 months if the patient has an implant device. SSIs pose a substantial barrier to healing and resumption of normal activities. SSIs and its side-effects have been noted as one of their primary contributors to the morbidity following surgery. This study will look at the incidence and severity of infections at the surgical site after both emergency and elective abdominal surgery. Methods: This is prospective observational research in patients who underwent Surgeries in either elective or emergency settings. Southampton wound assessment scale and the ASEPSIS wound scoring system were used in grouping the patients with SSI followed by each patient's SSI type was further recorded. The study also documented other factors, such as hospital stay and interventions. Results: There were one fifty participants in this study. 23 patients experienced SSI (6 elective cases and 17 emergency cases), while 127 people did not. The pathogens most commonly cultured were coagulase negative staphylococcus (CoNS, 8 cases), after which came Escheria coli. (4 cases). Conclusion: A higher prevalence of SSI is linked to factors including the patient's advancing age, a dirty wound, prolonged surgery, usage of drains, nutritional deficiency, anemia, and diabetes. The hospital personnel need to be more careful about following aseptic procedures and have more awareness of infection management.

A review of artificial intelligence in wound care

Our aging population, diabetes, and obesity have fueled the growth of chronic wounds seen throughout the world. Often, wounds are a marker of poor health that leads to increased mortality rates. However, the diagnosis and treatment of these wounds are challenging. Incorrectly differentiating between chronic wounds and other complex conditions can lead to adverse events. Artificial intelligence (AI) has been shown to offer some early benefits, and we hypothesized that it may enhance wound care but also carry some notable risks. We performed a detailed search using PubMed, Scopus, Cumulated Index in Nursing and Allied Health Literature, and Web of Science for AI applications in wound care. AI was found to be applied to wound diagnosis and characterization, wound monitoring for tissue change, daily therapy, and prevention and prognostics. AI made for more efficient and accurate wound assessments, less painful assessments of chronic wounds, more personalized treatment, and improved prognostic prediction capabilities. AI also allowed for more precise at-home observation and care, facilitating earlier wound treatment as needed. Challenges associated with AI included how to best allocate AI-assisted technologies equitably, how to safely maintain patient data, and how to diversify datasets for algorithm training. Because the algorithms are not transparent, validating findings may be challenging. AI presents a powerful tool in several aspects of advanced wound care and has the potential to improve diagnoses, accelerate healing, reduce pain, and improve the cost-effectiveness of wound care. More research needs to be done into how to best incorporate AI into daily clinical practice while keeping clinicians aware of the potential risks of using these evolving technologies.

A dedicated wound care module for third-year baccalaureate nurses: does it increase their knowledge and confidence?

Wound care is an important component of nursing care, consuming a significant amount of working hours. Literature reports the existence of many barriers to evidence-based wound care and that nursing students have an increasing need for education in this field. While blended learning activities have shown some benefits in learning outcomes, dedicated wound care modules within baccalaureate nursing courses occur infrequently. The aim of this study was to facilitate an increase in confidence and knowledge of evidence-based wound care in third-year baccalaureate nursing students. In this descriptive pre-post research design, a dedicated wound care module within a baccalaureate nursing course (using a constructivist learning approach) was offered to students in a university in Australia. Pre- and post-implementation surveys were completed (2018-2020). Due to a small number of matching participants, only descriptive statistics were calculated for all variables. A total of 276 students were invited to respond to the survey and 41 responded initially, 35 responded post the wound care module, and 26 responded to the survey after six months. Positive outcomes were noted in increased levels of confidence in the student nurses' ability to assess, manage and prevent wounds; as well as to apply evidence-based practice and change management following the educational wound care module within the baccalaureate nursing course. Implementation of a dedicated wound care module within a baccalaureate nursing course in this sample of third-year students fostered a positive change in the knowledge of evidence-based wound management, assessment and prevention. Education of the next generation of registered nurses in this valuable area of practice is an important part of baccalaureate nursing education.

Spatially controllable fluid hydrogel with in-situ electrospinning PCL/chitosan fiber for treating irregular wounds

Skin injuries sustained during exercise are often irregular in shape and frequently accompanied by infections. Bacteria residing in the crevices of these wounds can lead to persistent infections. Routine wound monitoring, which requires removing the wound dressing to assess recovery, is inconvenient and increases the risk of infection. To address this, we prepared a polyvinyl alcohol/polyhydroxylated fullerenes ((PVA/PHF) hydrogel with good fluidity and photothermal antibacterial properties, which can penetrate into the crevices of irregular wounds. After the hydrogel was applied to the wound, the hydrogel was locally defined by the polycaprolactone/Chitosan (PCL/CS) membrane of in-situ electrospinning, which effectively killed bacteria, and the healing efficiency was increased by 240 % in the wound healing experiment. The PVA/PHF hydrogel exhibits excellent electrical conductivity, making it suitable for real-time monitoring of human body motion as a strain sensor. This capability provides doctors with an accurate basis for wound assessment. At the same time, the hydrogel can achieve self-healing within 1.5 s and withstand up to 2200 % tensile strain, which can be used for large-scale motion monitoring of the human body. This flowable hydrogel, capable of penetrating wound crevices, offers a dual function of both treatment and monitoring.

Using Range of Motion Exercises and Smartphone Thermography to Evaluate Wound Healing in Second-Degree Burns

BackgroundBurn injuries can lead to devastating functional impairments and reduced quality of life. An important component of rehabilitation programs is the range of motion exercises, which can accelerate wound healing and prevent contractures. The present study sought to evaluate the effects of a range of motion exercises validated by thermal imagining on patients with second-degree burns. Patients and methodsThis quasi-experimental study included 47 adult patients diagnosed with second-degree burns. Data was collected using a Structured Interview Questionnaire, modified Abbreviated Burn Severity Index (ABSI), the Bates-Jensen Wound Assessment Tool (BWAT), and mobile thermal imaging to assess wound healing. ResultsThe ABSI levels showed that 46.8% of patients had moderate-severity burns, 38.3% had very low severity, and 14.9% had moderately severe burns. While the BWAT scores were 28.9 ± 4.6SD at baseline, 30.1 ± 4.7SD after one week, 19.2 ± 6.5SD after the 2nd week, and finally 17.1 ± 4.3SD on the 3rd week. The FLIR thermal imaging scores over three weeks were statistically significant (p<0.001, Kruskal-Wallis test). The study revealed high statistically significant differences in range of motion and wound healing mean scores. ConclusionsThis study demonstrated that range of motion exercises improved burn wound healing. Additionally, thermal imaging showed high validity for evaluating wound healing potential and progression. It provides viable triage technology while benefiting clinical assessment. Overall, range of motion and smartphone thermography are two evidence-based modalities that can enhance burn management, decrease healing time, lower costs, and improve outcomes.

Wound Pain Management: The Present and the Future

Wound pain is a common issue during wound care procedures such as dressing changes and debridement, significantly affecting patient comfort and recovery. Effective pain management is essential, not only for enhancing quality of life but also for promoting healing and minimizing complications. Factors like resting pain intensity, expected pain, and type of dressing have been identified as key predictors of severe wound pain during these procedures, helping clinicians manage pain more effectively by enabling early intervention. The Wound Pain Management Model was developed to guide healthcare professionals in managing chronic wound pain through steps like wound assessment, local treatment, and systemic management when necessary. While opioids are a common treatment, concerns over dependence and side effects have led to the exploration of alternatives. Virtual reality (VR) has emerged as a promising non-pharmacological approach, reducing pain through distraction, particularly in burn and chronic wound care. However, variability in study designs limits the current understanding of VR’s overall effectiveness. This review examines both pharmacological and non-pharmacological approaches to wound pain management, with a focus on VR. Further research with larger, more consistent studies is needed to better assess VR’s long-term benefits across different patient groups and wound types.

Effectiveness of Wound Irrigation Using Hypochlorous Acid Liquid on Healing of Diabetic Foot Wounds

Background: Wound cleansing is crucial in wound healing, depending on the method and type of solution used. Hypochlorous Acid is one of the wound irrigation options that can be applied in this process. Objective: This study aims to evaluate the effectiveness of wound irrigation using Hypochlorous Acid (HOCL) on diabetic foot wound healing. Methods: This quantitative research employs a quasi-experimental design, involving 13 diabetic foot wound patients selected through total sampling. Interventions were conducted over five weeks, totaling ten sessions. The Bates-Jensen Wound Assessment Tool (BJWAT) was utilized to assess wound healing, and data were analyzed using SPSS 25, applying paired T-tests to evaluate pre-and post-intervention differences. Results: A statistically significant improvement in diabetic foot wound healing was observed, marked by a p-value = 0.000, highlighting the potential of HOCL in promoting effective wound healing. Conclusion: HOCL wound irrigation significantly enhances diabetic foot wound healing

020. A Preliminary Study of Post-Reconstructive Basal Cell Carcinoma Scars with Hyperbaric Oxygen Therapy Using Bates-Jensen Wound Assessment Tool Erick Latun1, Mendy Hatibie Oley2, Stevy Suoth2

Background: Non-melanoma skin cancer is 18-20 times more common among Caucasians and has a lower fatality rate. The study also indicated that women have more basal cell carcinoma than men. Treatments for basal cell carcinoma include surgery and on-surgical methods. Hyperbaric oxygen therapy is meant to speed up wound healing and prevent scarring. Through the use of the Bates-Jensen Wound Assesment Tool, basal cell carcinoma patients who undergo adjuvant hyperbaric oxygen therapy will be assessed in this study. Methods: The Bates-Jensen Wound Assessment Tool were used to collect data in this preliminary study. Participants who met the criteria were interviewed and given questionnaires to complete. According to the variable type, data is processed descriptively. Results: Six participants who fulfilled the inclusion criteria were interviewed about their Bates-Jensen Wound Assessment Tool showed to have good outcome with low score after the use of hyperbaric oxygen therapy. Conclusion: The Bates-Jensen Wound Assessment Tool is projected to be lower in severity in patients receiving hyperbaric oxygen therapy than in other control groups in this study.

Initial treatment of severe soft-tissue injuries in closed and open fractures to prevent fracture-related infection

The management of soft tissue damage during fracture treatment requires surgical proficiency and meticulous care adhering to established treatment protocols. This approach is paramount for minimizing the risk of potentially limb- or even life-threatening complications such as fracture-related infection (FRI) in all age groups. There is a general consensus on essential measures such as wound assessment, surgical debridement and early use of antibiotics. Treatment should always be based on the correct classification of the fracture and the corresponding soft tissue injury, but needs to be adapted to the individual patient considering general health status, secondary diagnoses and currently available treatment options.

High Antimicrobial Electrotherapy and Wound Monitoring Hydrogel with Bimetal Phenolic Networks for Smart Healthcare

AbstractThe design and fabrication of novel soft bioelectronic materials for rapid wound healing and real‐time monitoring are critical for smart healthcare. However, developing such integrated multifunctional materials devices remains challenging due to fabrication dynamics and sensing interface issues. Herein, a novel strategy is presented for accelerating the kinetics of hydrogels integrating antimicrobial, electrotherapeutic, and wound monitoring functions via bimetallic phenolic networks. The Al3+ catalyzes the radical copolymerization reaction of acrylic acid, resulting in the gelation of the system within 10 s, and also catalyzes the redox reaction between silver and lignin, inducing the sustained release of catechol, which significantly enhances the hydrogel's antimicrobial activity and shortened the wound healing process. Meanwhile, the abundant non‐covalent interactions enhance the hydrogel's tissue adhesion, and mechanical properties (tensile strength 1.558 MPa and elongation 1563%). In addition, the bimetallic ions endow the hydrogels with excellent sensing properties. Under the synergy of electrical stimulation, the wound healing rate is accelerated. Notably, wound assessment can be performed by monitoring changes in electrical signals over the wound, which can assist physicians and patients in achieving intelligent wound management. This work provides new insights into the design and application of multifunctional smart bioelectronic materials.

THE EFFECT OF SIGPROCARE HOCl 0.01% ON TIME MANAGEMENT OF DIABETIC MELLITUS WOUNDS IN BUKITTINGGI CITY IN 2024

Diabetes mellitus is a chronic disease cause by high leves of glucose in the blood, as well as accompanying metabolic disoders. One of the main factors causing diabetes mellitus wwounds is lifestyle, including the consumption of high-sugar foods. This research aims to determine the effect of using Sifprocare HOC1 0.01% on the wound healing proceess of diabeetes mellitus in Bukittinggi City. The method used was quantitative research with a Quasi-Ecperimental design and One Group Pretest-Posttest approach. The populastion in this research were all patients with indications of diabetes mellitus wounds in Bukittinggi City, and the research was conducted from February to June 2024. The research sample amounted to 10 respondents who were selected purposively. Data were analyzed univariately and bivariately using the BWAT (Bates-Jensen Wound Assessment Tool) obervation sheet and wound care SOP with Sigprocare HOC1 0.01%. The results of univariate analysis showed that the average diabetes mellitus wound score before Sigprocare HOC1 0.01% was 35.3, and after teatment the average dropped to 25.7. The result of biavariate analysis showed a significant effect of using Sigprocare HOC10.01% in the wound healing process of diabetes mellitus with a P value (0.000) &lt; a (0.05). The implication of thi research shows that Sigprocare HOC1 0.01% is effective in helping in healing process of diabetes mellitus wounds, so it is hoped that repondents can apply its use and maintain wound hygiene to accelerate recovery.

Recent technological advancements in Artificial Intelligence for orthopaedic wound management

In orthopaedics, wound care is crucial as surgical site infections carry disease burden due to increased length of stay, decreased quality of life and poorer patient outcomes. Artificial Intelligence (AI) has a vital role in revolutionising wound care in orthopaedics: ranging from wound assessment, early detection of complications, risk stratifying patients, and remote patient monitoring. Incorporating AI in orthopaedics has reduced dependency on manual physician assessment which is time-consuming. This article summarises current literature on how AI is used for wound assessment and management in the orthopaedic community.

Effectiveness of Polyhexamethylene biguanide Liquid for Chronic Wound Washing

Background: Chronic wounds occur due to a failure in the wound healing process and are currently one of the health problems that require proper management. Some types of chronic wounds include venous leg ulcer (VLU), diabetic foot ulcer (DFU). The use of wound washes is one of the factors that play an important role in chronic wound healing. Purpose: Effectiveness of Polyhexamethylene biguanide in cleaning wounds from old dressing residue and reducing bacterial counts. Methods: Quasi experiment without control group to 30 samples using Polyhexamethylene biguanide with BWAT wound assessment instrument (Bates Jensen Wound Assessment Tool), data processing using SPSS program with Wilcoxon test. Results: 17 (40%) were late elderly (56-65 years), 3 (20%) were early elderly (46-55 years), and 10 (20%) were seniors (&gt; 65 years). The bivariate Wilcoxon test shows that Polyhexamethylene biguanide wound cleansing liquid significantly changes mean values before and after wound care. Before wound care, the mean value was 34.65 ± 14.15, and after treatment, it was 7.87 ± 3.16. The mean difference is -5.14 (-12.24 to 2.56) with a 95% confidence interval, and the p value is 0.031. Conclusion: Polyhexamethylene biguanide was shown to be effective as a wound wash to support the healing process of chronic wounds. Suggestions based on the results of this study can be used for efficient chronic wound washing for patients.

Improving the Accuracy of Patient Self-Care After Joint Replacement Surgery

Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital's orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge. This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness. A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented. The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality. To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.

Usefulness of Platelet-rich Fibrin in Open Fractures of Tibia: A Randomised Comparative Pilot Study

Background and Aims: Platelet-rich fibrin (PRF), rich in growth factors and cytokines, found useful for bone healing in animal studies, has paucity of literature on open fractures in humans. This randomised comparative interventional study aimed to find out the role of PRF in wound healing and fracture union in open fractures of tibia. Material and Methods: Random computerised allocation of 14 open tibial shaft fractures managed with an external fixator were done into PRF and non-PRF groups. Autologous PRF injected at fracture site, with PRF gel over open wounds in the PRF group, was compared with conventional standard treatment in the non-PRF group. Wound assessment on day 3, day 7 and weekly till complete wound healing and radiographs for fracture union at 3, 6, and 12 months were done in both groups. The statistical analysis was done using an unpaired t-test (wound size assessment) and chi-squared test (fracture union), using SPSS version 25. Results: Fractures union in PRF group 7/8 (87.5%) was better than 3/6 (50%) in non-PRF group. External fixators were removed 4 weeks earlier in PRF group. Wound healing time, though not statistically significant, was faster in PRF group (36.25±3.03 days) compared to non-PRF (42±7 days), even with larger wound size in PRF group (7.87±1.43 cm 2 ) than non-PRF group (7.5±1.5 cm 2 ). Conclusions: Results of injectable PRF at fracture site and PRF gel over the wound are encouraging, found to be safe, with faster wound healing and better fracture union in the small sample size of this pilot study.

Audit of Antimicrobial Prescribing Trends in 1447 Outpatient Wound Assessments: Baseline Rates and Impact of Bacterial Fluorescence Imaging.

Background/Objectives: In the field of wound care, the prescription of antibiotics and antimicrobials is haphazard and irrational, which has led to unchecked overprescribing. Recent Joint Commission guidelines mandate that hospital outpatient clinics develop and implement antimicrobial stewardship programs (ASPs). Yet few ASPs exist in wound clinics across the United States (US). Understanding baseline prescribing practices and rates in the US is a critical first step toward rational antimicrobial use and effective ASPs. Methods: This prospective study was conducted across eight outpatient wound clinics from January-December 2022. Data from consecutive patients attending single-time-point initial visits were recorded, including clinical findings, antimicrobial prescribing trends, and sampling practices. Results: A total of 1438 wounds were included; 964 were assessed by clinical examination (standard of care, SoC), and 474 by clinical examination plus fluorescence imaging. SoC patients were prescribed more concurrent medications on average than fluorescence patients (1.4 vs. 1 per patient). Prescriptions were preferentially topical in the fluorescence group (92% vs. 64%, p > 0.0001), and systemic antibiotics represented 36% of the single items prescribed under SoC (vs. 8% in fluorescence group p < 0.0001). Conclusions: Fluorescence imaging provided objective and actionable information at the bedside, which led to a decrease in the use of antibiotics. Real-time diagnostic technologies are essential in establishing a meaningful ASP.

Forensic-radiological diagnosis of gunshot wounds

Although gunshot wounds are less common in Germany than in other countries, aproportion of suicides and violent crimes are committed with firearms, which is why basic knowledge of diagnosis is important. Fundamentals regarding forensic assessment of gunshot wounds are discussed alongside typical radiological findings. In addition to analyzing our own cases and evaluating official statistics, this article is based on adiscussion of basic research and expert recommendations. The article describes the characteristics of the bullet entry and exit as well as special features of the bullet trajectory, particularly in bony injuries, and discusses their significance for radiological findings. Pitfalls in interpretation, such as changes in body position and the deflection of projectile (fragments) in the body, are presented, as are the advantages of supplementary radiological diagnostics (projectile search before initiation of dissection, simple detection of an air embolism, clarity of bullet trajectory reconstruction). This article is intended to provide an overview of not only typical types of weapons and projectiles but also their effects on the body of the victim, which must be documented by the examiner.

SP1.8 - Reducing the burden to deliver remote postoperative surveillance using machine learning for surgical-site infection (SSI)

Abstract Aims Remote postoperative wound (RPW) surveillance has been shown to improve the delivery of care and minimise the harm to patients from surgical-site infection (SSI). The burden for healthcare staff to deliver is a major barrier to implementation, therefore we aimed to develop novel methods for automated assessment of RPW surveillance to reduce this. Methods This was a secondary analysis of two interventional studies on RPW surveillance: “Tracking wound infection with smartphone technology” (TWIST) and “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). Adult general surgery patients could submit images of their surgical wound(s), and patient-reported outcome measures (PROMs) of SSI for 30-days postoperatively. A multi-input neural network (MNN) was developed to predict a clinical diagnosis of SSI within 48h based on symptoms and wound images. Performance was evaluated using area under the curve (AUC) and externally validated. Results There were 1540 submissions containing PROMs (48h SSI rate = 3.7%, n=57) and 2615 images (48h SSI rate = 3.1%, n=82). The MNN exceeded performance of the component models within the external validation subset (AUC: 0.94, 95% CI: 0.89-0.99) and remained equivalent to clinician triage (AUC: 0.92, 95% CI: 0.90-0.94). Usage to screen out “low-risk” responses prior to clinical triage was estimated to reduce the staff-time required to deliver (6.3h vs 25.5h). Conclusion Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care, and allow resources to be appropriately directed to those at greatest risk of SSI.

Thermographic assessment of skin temperature after lumbar spine surgery: Useful method for detection of wound complications? A pilot study.

Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area. Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05). This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.

Augmented Reality-Based Chronic Wound Healing Assessment Using 3D Stereoscopic Imaging and Self-Organizing Maps

Background: Chronic wounds (CW) present significant public health challenges, impacting individuals' well-being and daily activities. Traditional wound measurement methods, such as the ruler technique, are time-consuming, imprecise, and pose infection risks. Advances in wound care technology, including artificial intelligence (AI) and augmented reality (AR), have improved wound healing (WH) assessment accuracy and enhanced clinician-patient communication. Methods: This study developed a novel CW evaluation device combining AR and a stereoscopic camera system. The device captures images using two Leopard Imaging LI-OV580 stereo cameras and a pico-projector to create a 3D wound model. The system calculates the wound area by processing stereoscopic images, utilizing structured-from-motion techniques and convolutional neural networks (CNNs). Additionally, the device measures epipolar and projection errors (PE) during AR-based wound evaluation. A Self-Organizing Map (SOM) was employed to refine the 3D reconstruction of the wound. Results: The AR-PE analysis demonstrated the device's accuracy, with the lowest PE recorded at 20 cm from the wound area. The projection error increased as the measurement distance moved toward the edges of the wound. The average epipolar error (EE) was 0.46 pixels, indicating high precision in stereoscopic measurements. Conclusion: The study introduced a non-invasive CW evaluation device that improves wound assessment accuracy and clinician-patient interaction. By utilizing 3D wound modeling and AR, the system enables more effective communication and progress tracking during WH. The results suggest this technology could enhance CW management, offering a reliable alternative to traditional methods.