Wound Care Clinic Research Articles

Efficacy of a bacterial fluorescence imaging device in an outpatient wound care clinic: a pilot study

Subsurface bacterial burden can be missed during standard wound examination protocols. The real-time bacterial fluorescence imaging device, MolecuLight i:X, visualises the presence of potentially harmful levels of bacteria through endogenous autofluorescence, without the need for contrast agents or contact with the patient. The intended use of the imaging device is to assist with the management of patients with wounds by enabling real-time visualisation of potentially harmful bacteria. The aim of this study was to establish the accuracy of the wound imaging device at detecting pathogenic bacteria in wounds. A single-centre, prospective observational study was conducted in Cork University Hospital in an outpatient plastic surgery wound care clinic. Patients had their wounds photographed under white and autofluorescent light with the imaging device. Auto-fluorescent images were compared with the microbiological swab results. A total of 33 patients and 43 swabs were included, of which 95.3% (n=41) were positive for bacteria growth. Staphylococcus aureus was the most common bacterial species identified. The imaging device had a sensitivity of 100% and specificity of 78% at identifying pathological bacteria presence in wounds on fluorescent light imaging. The positive predictive value (PPV) was 95.4%. The negative predictive value (NPV) was 100%. It demonstrated a sensitivity and specificity of 100% at detecting the presence of Pseudomonas spp. The imaging device used could be a safe, effective, accurate and easy-to-use autofluorescent device to improve the assessment of wounds in the outpatient clinic setting. In conjunction with best clinical practice, the device can be used to guide clinicians use of antibiotics and specialised dressings.

Effect of Red Fruit Oil Soap (Pandanus Conoideus Lam.) as Wound Cleansing on Wound Healing and the Number of Bacterial Colonies among Grade II Diabetic Ulcer Patients at Griya Wound Care Clinic Kudus, Indonesia

Background: Diabetic ulcer is an open wound on the skin layer to the dermis due to hyperglycemia and neuropathy. This condition often causes infection and becomes an inhibitor in the wound healing process. Red fruit oil soap can be used as an alternative cleansing to reduce the number of bacterial colonies and accelerate the wound healing process.Aims: This present study aimed to observe the effect of red fruit oil soap in the cleansing process to reduce the number of bacterial colonies and the wound healing process in grade II Diabetic ulcer patientsMethods: This is a quasi-experimental study with the pre-test post-test non-equivalent control group design. Wound cleansing in the intervention group used 0.9% NaCl solution and red fruit oil soap with a pH of 5.74, while the wound cleansing in the control group used 0.9% NaCl solution. Bacterial colonies were assessed and the type of bacteria was observed by the swab method. The wound healing was assessed with Bates-Jensen Wound Assessment Tool (BWAT) instrument for 14 days with observations every 3 days. Analysis test used Mann Whitney and Repeated Measure ANOVA.Results: There was no difference in the mean of the number of bacterial colonies between the wounds that were cleansed with 0.9% NaCl solution and red fruit oil soap and the wounds which were cleansed by using 0.9% NaCl solution (p> 0.05). The mean of the number of colonies in the intervention group until the 14th day reduced by 3.14x106 and in the control group was reduced h 1.40x106. There was a significant decrease in the wound healing scores in each group, in each assessment for 14 days.Conclusion: This study found that the wound cleansing using red fruit oil soap and 0.9% NaCl solution could reduce the number of bacterial colonies on the wound surface and accelerate the wound healing process among patients with grade II diabetic ulcer.

Comparing Human Amniotic Allograft and Standard Wound Care When Using Total Contact Casting in the Treatment of Patients with Diabetic Foot Ulcers.

This prospective, randomized study compared two treatments for diabetic foot ulcers: total contact cast and a skin substitute versus total contact cast and standard wound care. Researchers screened 270 adult outpatients in a Midwestern wound care clinic for inclusion. Adults 18 years or older with type 1 or 2 diabetes and a diabetic foot ulcer located on the plantar surface larger than 0.5 cm in area were invited to participate if they had not demonstrated a 50% reduction in wound area following 4 weeks of standard treatment. Thirteen patients were randomized into two intervention groups. The majority of the participants had type 2 diabetes. Group A treatment: total contact cast and a skin substitute (human amniotic allograft); group B treatment: total contact cast and standard wound care. Mean ulcer surface area, time to closure, recurrence rates, satisfaction with total contact casting, infection, and hemoglobin A1c were measured. The majority of participants experienced wound closure during the course of the study (92.3%). Two participants did not achieve closure, both of whom had Charcot foot. Group A, which had a higher mean hemoglobin A1c at study outset, experienced a longer mean time to closure (29.50 days) compared with group B (26.20 days). The 90-day recurrence rates were different for the two groups, with only one recurrence for group A (14.29%) but five recurring ulcers in group B (83.33%). Although significance was not established because of sample size, there was a definite trend toward significance that merits further investigation with human amniotic allograft.

Nutrition Supplementation and Education May Increase the Healing Rate in Diabetic Patients with Foot Ulcers (P19-005-19)

ObjectivesThis study examined the effects of high protein dietary supplementation and nutrition education on the healing of diabetic foot ulcers. MethodsTwenty-nine adults with diabetic foot ulcers were recruited from the Tallahassee Memorial Hospital Wound Care Clinic. Participants were randomly assigned to treatment (n = 15) or control (n = 14) group. The treatment group received two carbohydrate controlled high protein shakes to consume daily, and was educated regarding adequate intake of low-fat protein sources, fruits, vegetables, complex carbohydrates and minimizing simple carbohydrates. The control group did not receive any intervention. Daily supplementation provided a total of 500 kilocalories, 28 grams of high-quality protein, and approximately 50% of micronutrient requirements. Anthropometric measurements (weight, height, BMI) and wound planimetry were examined at baseline and every four weeks until the wound healed or up to 12 weeks. ResultsThere was no significant difference between the groups at baseline for BMI (mean = 33.8 ± 7 kg/m2), age (mean = 53.34 ± 11.14 years), duration of diabetes (mean = 13 years), duration of wounds (mean 10.8 months) or wound area (mean = 450 mm2). Wound healing rate (decrease in the area of the wound/week) for the treatment group was three times faster than the control group (151.1 mm2/week vs. 45.2 mm2/week respectively). ConclusionsImproved nutritional intake using nutritional supplementation and patient education has a strong positive effect on the wound healing rate of diabetic foot ulcers. Faster wound healing improves quality of life and functionality of patients with diabetic foot ulcers. Funding SourcesDissertation award.

Bacteriology of moderate-to-severe diabetic foot infections in two tertiary hospitals of Iran

BackgroundApproximately 25% of people with diabetes will experience diabetic foot ulcers (DFUs) during their lifetime. The present study was designed to determine the type of microorganisms isolated from the DFUs and their antibiotic resistance pattern, and to determine predisposing factors contributing to antibiotic resistance at the authors’ wound care clinic in Qazvin, Iran. MethodsA cross-sectional study was conducted from May to December 2017. One specimen for microbiological studies was obtained from the deep tissue. All demographic, clinical, and laboratory data and results of ulcer culture were collected for each case. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. A p value < 0.05 was considered significant. Results95 aerobic microorganisms were isolated from 105 specimens. Among Gram-positive and negative bacteria, Staphylococcus spp. and Escherichia (E). coli were the most frequent organisms isolated, respectively. Multidrug resistant (MDR) organisms constituted up to 48.4%, with 37.5% of isolated Enterococcus spp. being VRE, 48.8% of Staphylococcus spp. being methicillin-resistant, 77.8% of isolated E. coli being ESBL and 66.7% of isolated Pseudomonas being MDR. The minimum and maximum prevalence of resistance in Gram-negative bacteria were 17.6% and 87.5% for imipenem and ceftazidime, respectively. The prevalence of Gram-negative bacilli was higher in older patients (p value = 0.039) and rose markedly in patients with a higher number of hospitalizations (p value = 0.015). ConclusionDue to emergence of antibiotic resistance pathogens, culture specimens and antibiotic sensitivity testing are essential for correct management of the DFU infections and the selection of appropriate antibiotics.

Cost-effectiveness analysis of an innovative model of care for chronic wounds patients.

Current provision of services for the care of chronic wounds in Australia is disjointed and costly. There is large variability in the way that services are provided, and little evidence regarding the cost-effectiveness of a specialist model of care for treatment and management. A decision-analytic model to evaluate the cost-effectiveness of a specialist wound care clinic as compared to usual care for chronic wounds is presented. We use retrospective and prospective data from a cohort of patients as well as information from administrative databases and published literature. Our results show specialist wound clinics are cost-effective for the management of chronic wounds. On average, specialist clinics were $3,947 cheaper than usual clinics and resulted in a quality adjusted life year gain of 0.04 per patient, per year. Specialist clinics were the best option under multiple scenarios including a different cost perspective and when the cost of a hospital admission was reduced. Current models of care are inefficient and represent low value care, and specialist wound clinics represent a good investment compared to current approaches for the management of chronic wounds in Australia.

Nurses' Knowledge and Practices Related to Pressure Injury: A Cross-sectional Study.

The purpose of this study was to determine nurses' knowledge and practices regarding pressure injury and identify relationships between these factors and professional nurse characteristics. Cross-sectional, descriptive study. The sample comprised 347 nurses attending the 2013 and 2015 Wound Management Congresses. The meetings were organized by the Wound Management Association located in Antalya, Turkey. A 35-item data collection form was designed for purposes of this study. It divided into 2 parts: 8 items queried demographic and professional characteristics of nurse respondents. The second part comprised 9 cases describing patients with pressure injury; these cases were associated with 27 items querying pressure injury-related knowledge and practices. Demographic and professional characteristics of nurse respondents were summarized via descriptive statistics. The Kruskal-Wallis H and Mann-Whitney U tests were used to identify relationships between nurse characteristics and pressure injury knowledge and practices. The mean score for the 27 items related to pressure injury knowledge and practices was 57.37 ± 14.26 out of 100 points. Pressure injury knowledge and practices were positively associated with nurses having a bachelor's and/or postgraduate degree (P = .012), nurses caring for a higher number of patients with pressure injuries per week (P = .042), nurses practicing in intensive care units and wound care clinics (P = .011), nurses with specific education in pressure injury (P = .000), and those indicating adequate skills and knowledge in pressure injury (P = .005). Nurses' knowledge and practices regarding pressure injuries were lower than anticipated in this sample. We recommend additional education and training activities to increase nurses' knowledge and practices related to pressure injury.

Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic.

Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU). The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic. Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05). Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.

Treatment of chronic osteomyelitis with multidose oritavancin: A case series and literature review

Osteomyelitis remains difficult to treat, typically requiring a prolonged course of intravenous (i.v.) antibiotics. The optimal route and duration of antibiotics remains ill-defined due to limited prospective clinical trials. Oritavancin is a long-acting, semisynthetic lipoglycopeptide antibiotic with rapid concentration-dependent bactericidal activity against many Gram-positive organisms. Favourable pharmacokinetics makes oritavancin an appealing alternative to currently available antibiotics requiring daily infusion to decrease the risk of vascular access complications associated with outpatient antimicrobial therapy. The purpose of this study was to report the outcomes of nine patients with chronic osteomyelitis receiving multidose oritavancin. Using electronic medical records, patients aged ≥18 years treated with i.v. oritavancin between September 2015 and April 2018 at Downtown Dublin Wound Center, a hospital-owned outpatient wound care clinic and infusion centre affiliated with Meadows Regional Health System in Dublin, GA, were identified. Of 12 cases reviewed, 9 patients received at least two doses of i.v. oritavancin for the treatment of chronic osteomyelitis. All nine patients experienced clinical cure at 6-month follow-up after the last dose of oritavancin. Multidose oritavancin was found to be a safe and efficacious option for chronic osteomyelitis when treatment options are limited by patient complexities or barriers in their ability to access healthcare services.

PROSES PENYEMBUHAN LUKA ULKUS DIABETIKUM DENGAN METODE MODERN DRESSING DIKLINIK MAITIS EFRANS WOUND CARE

Diabetes mellitus (DM) is one of the most common chronic diseases experienced by the world population and ranks fourth cause of death in developing countries. Long-term complications of diabetes mellitus one of them is diabetic ulcer (15%) and is the most cause (85%) of amputation in patients with diabetes mellitus. Currently, more than 5,000 modern types of dressings are reported to be available to treat wounds, especially diabetic ulcers. To know the process of wound healing diabetic ulcer was done with the design of case study research with a sample of 2 people and this study was conducted for 4 weeks. The study was conducted at the Maitis Efrans Wound Care clinic in Bengkulu City. The result was obtained that the assessment of diabetic ulcer wounds before modern wound care on the respondents was a total score of 54 and the respondents two total score of 50 were stated wound regeneration. The healing process of the responder's second ulcers progressed, the total score of one respondent was 30 and the respondent two was 28. Respondents. Progress on the two respondents stated better influenced by wound healing factor that is, age factor.

Establishing a multidisciplinary partnership integrating podiatric care into the Quebec public health-care system to improve diabetic foot outcomes: A retrospective cohort

Diabetic foot ulcers (DFUs) are one of the main complications of diabetes affecting many Canadians that need to be effectively managed. There is limited data concerning outcomes of Canadian patients with DFUs treated with a team approach in the public health system. Podiatrists are known to be key members of a multidisciplinary team approach to DFUs management, but in Quebec, Canada, they are only available in private practice. The aim of this study is to evaluate diabetic foot outcomes after integrating podiatric care into in-hospital wound care clinic settings. A 12-month retrospective cohort study was conducted into a new organization named the Pododiabetology University Center (PUC), which is described in this article. Healing rate and healing time were the outcomes measured. The analysis was performed by comparing data collected before and after the integration of the podiatrists. Preliminary results indicate that 73.2% of DFUs (n=52) healed in an average of 19.8 weeks (time to wound closure). Previous data collected on 15 individuals before the integration of podiatric care showed a 27.3% of DFUs resolved in 44.6 weeks. The findings suggest that a patient with DFUs who receives wound care from a multidisciplinary team that includes a podiatrist can improve both their healing rate and time. An integrated multidisciplinary approach including podiatrists for patients affected by acute DFU is highly suggested in the literature in order to reduce the number of hospitalizations, amputations and financial burden, which are variables that could be evaluated in further studies.

Perception of users on self-care of lower leg ulcers.

To know the perception of users on self-care of ulcers in the lower limbs. This is a qualitative, exploratory, and descriptive study conducted with 10 users registered in the complementary programme of a wound care clinic in Canoas, RS, Brazil. Data were collected using information from the medical records of the users and semi-structured interviews conducted between October and November 2016. The results were discussed according to thematic content analysis with three thematic categories: self-care and living with the ulcer, self-care deficit and supporting users with ulcer, and self-care and the ulcer care network, based on the Nursing Self-Care Deficit Theory. Self-care is the result of dialogue between the user/nurse/health workers and the link they establish when they share care. The support of family members and the service can facilitate or limit care.

Autolytic and Conservative Sharp Wound Debridement for Granulation Tissue on Unstageable Diabetic Foot Ulcer

Diabetic foot ulcer (DFU) is a condition of deep tissue damage associated with Diabetes Mellitus in the lower extremities. Conducted with quantitative research of single group method with pre and post test design approach, this research primarily aims to know the effectiveness of utilizing combination of Autolysis &amp; Conservative Sharp Wound Debridement in preparing granulation on unstageable DFU. It involved 30 respondents in the wound care clinic as the research sample and used the Wound Bed Score observation sheets measured on days 1, 7 and 28. The data analysis to determine effectiveness before and after intervention was carried out using dependent t-test (paired t-test), whilst to test effectiveness of giving intervention after controlled confounder was performed by linear regression. Based on the characteristics of the respondent’s, it is revealed that most of them were female (83.3%)&#x0D; and have normal BMI (80%). The average age of the respondents were 55.43 years old with the duration of DM of 13.27 years with average blood sugar of 101.2 mg/dL. The highest mean difference was on the 1st day of the 28th. The statistical results of this study indicated that the mean difference values for day 1 and 7 were 0.133 (SD 1.19, p value = 0.546), mean difference of day 7 and day 28th grade was of 2.5 (SD 1.306, p value=0.0001) and mean difference between day 1 and day 28 was of 2.63 (SD 1.273, p value=0.0001). This research recommends that the further research use different research methods.

Factors Contributing to Increased Patient Wait Times in Selected Wound Care Patients: A Retrospective Study

Background: ‘Waiting’ can be frustrating for anyone especially when it comes to healthcare. The Institute of Medicine advocates changes to improve the quality of the health care delivery system in the United States.Purpose: The purpose of this retrospective study was to determine the factors contributing to increased patient wait times in selected wound care patients. The question guiding this project is-in selected wound care patients who received treatment between September1-December 31, 2013; are factors contributing to prolonged wait times related to treatment-related diagnosis, providers, and clinicians?Method: After institutional review board approval, retrospective charts review was conducted. 300 charts were randomly selected from the electronic health record (EHR) database at a local hospital wound care clinic. 120 charts met the inclusive criteria and were analyzed using ANOVA and SPSS version 22. The Deming cycle for quality improvement was adopted as the framework for practice review and changes.Result: Among all the factors examined, Treatment diagnosis accounted for 4% of the variance (p = 0.416); Providers 1% (p = 0.208); and Clinicians 8% (p = 0.195). Though clinicians had the highest variance, it was not a significant factor for patient wait times. The Deming cycle helps to prioritize and improve communication by creating a chart for effective patient flow through the clinic to reduce wait time.Conclusion: Correcting and improving wait times has the potential for increasing timely access and patient satisfaction. Clinicians and providers are not significant factors contributing to wait times. Wait time should be given priority and be regularly reviewed as part of the quality improvement plan within any organization.

Outpatient Surgical Management of Patients with Complex Wounds Through a Multispecialty Wound Care Clinic

Category: Diabetes Introduction/Purpose: Management of patients with lower extremity wounds is complex and generally attributed to diabetes, neuropathy, and/or peripheral vascular disease (PVD). Often, these patients have poor control of their disease and limited resources. Hospitalizations related to lower extremity wounds are expensive with relatively high length of stay. Much of this time is spent organizing outpatient interventions. The purpose of this study is to evaluate the efficacy of outpatient surgical management of patients with lower extremity wounds that could lead to hospitalization. We hypothesize that through a multispecialty wound clinic, utilizing wound care specialists, orthotist/prosthetist, infectious disease specialist, and orthopaedic surgeons, at-risk patients could be identified for non-healing wounds through successful outpatient surgical management with preoperative insurance approval of postoperative wound care, offloading devices and antibiotic treatment. Methods: Patients seen through our outpatient multispecialty wound clinic were evaluated and those who underwent an outpatient surgical procedure over a 12-month period were identified. Additional inclusion criteria included failure of non-surgical management and 90-day minimum follow-up. Exclusion criteria included any patient who was septic, medically unstable, or unable to comply with the postoperative plan. Preoperative parameters regarding disease severity (HbA1c), infection severity (WBC, ESR, CRP), and wound healing potential (albumin, total protein) were identified. In addition, preoperative determination of wound severity was measured using Wagner’s Score. Outcomes included hospitalizations related to their wound within 90 days, requirements for additional surgical procedures, and time to resolve their wound postoperatively. Results: Nineteen patients met the inclusion criteria. Average age was 58.6 years and eleven were male. Ten had diabetes, thirteen had neuropathy, and five had PVD. Average preoperative HbA1c was 7.9, and average WBC, CRP, ESR, albumin, and total protein was 8.1, 1.1, 29.6, 3.7, and 7.0, respectively. All patients had preoperative conservative intervention. Eight patients were preapproved for outpatient IV antibiotics and four for wound vac therapy. Table 1 outlines the procedures performed. Patients presented an average of 7.3 weeks following their outpatient procedure until resolution of their wound. One patient was re-admitted to the hospital within 90 days for a problem related to their initial wound. Conclusion: Our study demonstrates that outpatient surgical management of medically stable patients with lower extremity diabetic, neuropathic, and/or PVD wounds resulted in wound resolution and eliminating hospitalization. This is accomplished with the preoperative organization through a multispecialty wound care clinic for patient’s postoperative needs, eliminating the time spent in the hospital during admissions waiting for OR availability, insurance approval and organization of outpatient wound care and antibiotics. This traditional process results in high medical costs without active intervention. Outpatient management can save valuable hospital resources as well as a substantial cost savings by eliminating days spent in the hospital.

A new approach to clinical research: Integrating clinical care, quality reporting, and research using a wound care network-based learning healthcare system.

The disparity between ideal evidence from randomized controlled trials and real-world evidence in medical research has prompted the United States Food and Drug Administration to consider the use of real-world data to better understand safety and effectiveness of new devices for a broader patient population and to prioritize real-world data in regulatory decision making. As the healthcare system transitions from volume- to value-based care, there is a growing need to harness the power of real-world data to change the paradigm for wound care clinical research and enable more generalizable clinical trials. This paper describes the implementation of a network-based learning healthcare system by a for-profit consortium of wound care clinics that integrates wound care management, quality improvement, and comparative effectiveness research, by harnessing structured real-world data within a purpose-built electronic health record at the point of care. Centers participating in the consortium submit their clinical data and quality measures to a qualified clinical data registry for wound care, enabling benchmarking of their data across this national network. The common definitional framework of the purpose-built electronic health record and the 21 wound-specific quality measures help to standardize the potential sources of bias in real-world data, making the consortium data useful for comparative effectiveness research. This consortium can transform wound care clinical research and raise the standards of care, while helping physicians achieve success with the Merit-Based Incentive Payment System.

Impact of home visits on the functional capacity of patients with venous ulcers.

to compare the impact of home visits, before and after instructions, on the functional capacity of adult and elderly patients with venous ulcers, by means of the KATZ-EIAVD Scale. experimental, clinical, randomized, non-blind and controlled study, developed with 32 patients (case and control groups). The research settings were the Wound Care Clinic of the University Hospital Antonio Pedro, and the homes of patients assisted in this clinic. Data collection took place from February to June 2014, by means of a health unit evaluation tool, the KATZ-EIAVD Scale, and a script of instructions to be given to the research subjects that had received a home visit. the studied population present excellent independence for activities of daily living, with no significant variation among them. the studied groups have functional capacity with similar progress.

Clinic visit frequency in wound care matters: data from the US wound registry.

A previous study suggested that the frequency with which patients visit wound care clinics influences the rate of chronic wound healing but high bias was present with regard to wound care centre selection. The objective of this retrospective cohort study was to confirm this finding by using a very large sample size of diabetic foot ulcers (DFUs) from the US Wound Registry. Patients who visited the clinic more than once for a new DFU were eligible for study inclusion. No exclusion was made with regard to Wagner grade, wound severity, or patient comorbidity. A Cox regression was conducted to analyse time to heal within 1 year using covariates known or suspected to influence wound healing, including visit frequency. In terms of relative effect size, covariates that impeded wound healing the most were wound age and visit frequency with lower visit frequencies associated with lower probabilities of wound healing. Compared with DFUs (n=39,750) seen at a frequency of 7.5 times or more per 4 weeks, wounds seen at intervals of 2 weeks or less had a hazard ratio of 0.098 [(95% confidence interval: 0.09-0.11]. Using a separate breakpoint of ≥2 versus < 2 per 4 weeks specifically for the estimate of overall effect size, Cohen's w was 0.14-a small-to-medium effect size. Our findings confirm previous work and have implications for clinical practice and analysis of uncontrolled studies.

A Multicenter Evaluation of Chronic Ulcer Recurrence with the Use of Varying Mechanical Wound Healing Modalities

Chronic wound care is a growing medical problem, reaching epidemic proportions worldwide. Even after the wound has healed, wound recurrence remains a significant issue, with rates approximating 40% in 6 months after healing. The authors evaluate a retrospective analysis of their wound care clinics healing and recurrence rates. The authors evaluate the efficacy of varying physical modalities on preventing recurrence of wounds after their healing. The authors take their evaluation out to one year.

Translation and cross-cultural adaptation of the Cardiff Wound Impact Schedule to Brazilian Portuguese

AimTo translate into Brazilian Portuguese and cross-culturally adapt the Cardiff Wound Impact Schedule, a specific measure of health-related quality of life (HRQoL) for patients with chronic wounds. Chronic wounds have a relevant impact on the HRQoL of patients. However, there are few instruments cross-culturally adapted and validated in Brazil to assess HRQoL in patients with wounds. MethodsA descriptive cross-sectional study was conducted following six steps: (1) translation of the original instrument into Brazilian-Portuguese by two independent translators; (2) construction of a consensus version based on both translations; (3) two independent back-translations into English of the consensus version; (4) review by an expert committee and construction of the pre-final version; (5) testing of the pre-final version on patients with chronic wounds; and (6) construction of the final version. The psychometric properties of the instrument were tested on 30 patients with chronic wounds of the lower limb; 76.7% were men, 70.0% had traumatic wounds, and 43.3% had the wound for more than 1 year. Participants were recruited from an outpatient wound care clinic in São Paulo, Brazil. ResultsThe final version approved by the expert committee was well understood by all patients who participate in the study and had satisfactory face validity, content validity, and internal consistency, with Cronbach's alpha coefficients ranging from 0.681 to 0.920. ConclusionThe cross-culturally adapted Brazilian-Portuguese version of the instrument showed satisfactory face and content validity, good internal consistency, and was named Cardiff Wound Impact Schedule-Federal University of São Paulo School of Medicine or CWIS-UNIFESP/EPM.