Wound Care Providers Research Articles

The characteristics and impact of hard-to-heal wounds: results of a standardised survey.

The effective management of hard-to-heal wounds has increasingly important implications for those who provide wound care services within healthcare systems. The burden of wounds in the population continues to grow, as does the demand for wound care, against a backdrop of cost constraints and increasing expectations. The need to improve both outcomes and efficiency in wound care is therefore paramount and the time taken to heal wounds is an important factor in determining both. Survey methodology was used to collect data across 10 community wound care providers in the UK, Ireland, Finland, Norway and Denmark between February and August 2017. This allowed for analysis of wounds and their characteristics, dressing selection and nursing practice across a typical wound caseload. Data from 1057 wounds demonstrates that the characteristics and consequences of hard-to-heal wounds are different from improving wounds. However, wounds are, in general, treated in the same way, irrespective of whether they are hard-to-heal or improving, suggesting that the healing status of a wound is not a major factor in treatment selection. Early intervention to return hard-to-heal wounds to a healing trajectory may be a useful approach to improving efficiency in wound care.

Foundation doctor knowledge of wounds and dressings is improved by a simple intervention: An audit cycle-based quality improvement study.

BackgroundMany foundation year 1 and 2 doctors (FYs) have limited knowledge experience in wound management. Wound dressing formularies exist in many NHS Trusts, though awareness of and adherence to them by FYs is not known. This quality improvement study described baseline FY knowledge of wound management, and investigated whether this could be improved through educational intervention.MethodsA single-centre, prospective, baseline audit was conducted following local approval. This assessed knowledge of wound types and appropriate dressings alongside individual confidence providing wound care. The educational intervention involved the distribution of an ID-badge sized quick reference guide that could be attached to the FYs' lanyards, and an introduction to the formulary during routine teaching. The audit loop was closed by repeating the questionnaire.ResultsPre- (n = 43) and post- (n = 35) intervention questions were completed by FYs. The mean score post-intervention was significantly higher than the pre-intervention score across all knowledge questions (from 32% correct to 71% correct, p < 0.0001). There was no change in participant confidence, which remained low.ConclusionFYs lack confidence and knowledge about wounds and dressings. The latter can be improved through a simple and practical educational intervention that could be deployed nationally.

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa.

ABSTRACTOBJECTIVETo describe venous ulcer care and wound care practices in Gauteng, a province of South Africa, according to the Donabedian structure-process-outcome quality improvement model.METHODSForty-eight facilities were selected randomly from public and private wound care practices in Gauteng. Structured interviews were conducted with care providers via questionnaire to assess the structural aspects of the Donabedian model. Within these facilities, investigators randomly selected 160 patient files and extracted data using a checklist to assess processes implemented and outcomes reached for patients who had previously presented with lower-leg venous ulcers.RESULTSFacilities lack the necessary equipment to perform vital assessments. Handheld Dopplers were available in 66% (n = 48) of the facilities. Sixty-one percent (n = 48) of the personnel at the facilities indicated that they had no formal wound care training. Although the majority of files (92%, n = 147) indicated that an assessment tool was used, many elements were not evaluated comprehensively according to the best available evidence. Aspects such as smoking, body mass index, and anemia were assessed in fewer than 30% of the patients. Distinguishing between superficial and deep infection and the accompanying overuse of antimicrobials and antibiotics were among the challenges identified. Further, 71% of patients received compression therapy, although the ankle-brachial pressure index of only 30% of patients was known. In 27 cases (17%), the outcome was amputation.CONCLUSIONSFrom this survey, it is evident that not all clinicians providing wound care in Gauteng are adequately trained or fully implementing best practice guidelines, and the consequences are detrimental to patients, particularly in terms of amputation. This article highlights the need for improved legislation and regulation for practitioners who deliver wound care services.

Discharge to a Post-Acute Care Facility after Emergent Femoral Artery Repair is Not Protective Against Wound Complications

Access site complication is the most common adverse event after endovascular intervention, and when emergent operative repair of the common femoral artery (CFA) is needed, patient morbidity can be significantly increased. The intent of this project was to identify predictors of wound events after emergent operative repair of the CFA due to an access site complication. It was hypothesized that patients discharged to a facility would benefit from an ongoing relationship with healthcare professionals as evidenced by more consistent follow-up and lower wound complication rates. Patients who had a percutaneous CFA access complication and required emergent open CFA repair at an academic medical institution between 2015 and 2018 were included, and the charts were reviewed retrospectively. Primary outcomes included wound complication and outpatient compliance with vascular surgery clinic visit. Dichotomous groups were evaluated by the chi-squared test, and continuous variables were evaluated by Student's t-test. Univariate and multivariate regression analyses were completed to assess risk factors contributing to wound event or failure of clinic follow-up. Forty-four patients were identified with emergent CFA repair due to an access complication between July 2015 and June 2018. Among this population, 33% of patients had wound complications and 27% were discharged to a facility. Among those discharged to a facility, the rate of follow-up to the vascular surgeon's clinic was significantly lower than those discharged to home (40% vs. 85%, P<0.05), and the incidence of wound complications appeared greater but did not reach statistical significance (50% vs. 27%, P=0.11). Univariate analysis indicated that kidney disease, albumin <3g/dL, and current smoking were predictive of wound complication, whereas on multivariate analysis, only kidney disease remained predictive (P<0.05, odds ratio=22). The modified frailty index (mFI) was not predictive of wound complications or compliance with follow-up. However, mFI did approach statistical significance when predicting discharge to a facility. Despite the availability of medical personnel to arrange transportation and provide wound care in post-acute care facilities, patients who were discharged to a facility after CFA injury requiring emergent repair experienced lower compliance with clinic follow-up and may have suffered more wound complications. Strategies to improve compliance with patient follow-up and wound healing in patients sent to post-acute care facilities are warranted.

Expect delays: poor connections between rural and urban health systems challenge multidisciplinary care for rural Americans with diabetic foot ulcers

BackgroundRural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. We sought to identify health system barriers contributing to this disparity.MethodsWe interviewed 44 participants involved in the care of rural patients with DFUs: 6 rural primary care providers (PCPs), 12 rural specialists, 12 urban specialists, 9 support staff, and 5 patients/caregivers. Directed content analysis was performed guided by a conceptual model describing how PCPs and specialists collaborate to care for shared patients.ResultsRural PCPs reported lack of training in wound care and quickly referred patients with DFUs to local podiatrists or wound care providers. Timely referrals to, and subsequent collaborations with, rural specialists were facilitated by professional connections. However, these connections often were lacking between rural providers and urban specialists, whose skills were needed to optimally treat patients with high acuity ulcers. Urban referrals, particularly to vascular surgery or infectious disease, were stymied by 1) time-consuming processes, 2) negative provider interactions, and 3) multiple, disconnected electronic health record systems. Such barriers ultimately detracted from rural PCPs’ ability to focus on medical management, as well as urban specialists’ ability to appropriately triage referrals due to lacking information. Subsequent collaboration between providers also suffered as a result.ConclusionsPoor connections across rural and urban healthcare systems was described as the primary health system barrier driving the rural disparity in major amputations. Future interventions focusing on mitigating this barrier could reduce the rural disparity in major amputations.

Complex Wound Healing Outcomes for Outpatients Receiving Care via Telemedicine, Home Health, or Wound Clinic: A Randomized Controlled Trial.

Use of telemedicine has expanded rapidly in recent years, yet there are few comparative studies to determine its effectiveness in wound care. To provide experimental data in the field of telemedicine with regard to wound care, a pilot project named "Domoplaies" was publicly funded in France in 2011. A randomized, controlled trial was performed to measure the outcomes of patients with complex wounds who received home wound care from a local clinician guided by an off-site wound care expert via telemedicine, versus patients who received in-home or wound clinic visits with wound care professionals. The publicly funded network of nurses and physicians highly experienced in wound healing was used to provide wound care recommendations via telemedicine for the study. The healing rate at 6 months was slightly better for patients who received wound care via telemedicine (61/89; 68.5%) versus wound care professional at home (38/59; 64.4%) versus wound care clinic (22/35; 62.9%), but the difference was not significant (P = .860833). The average time to healing for the 121/183 wounds that healed within 6 months was 66.8 ± 32.8 days for the telemedicine group, 69.3 ± 26.7 for the wound care professional at home group, and 55.8 ± 25.0 days for the wound care clinic group. Transportation costs for the telemedicine and home health care groups were significantly lower than the wound clinic group, and death rate was similar between all the 3 groups (P < .01). Telemedicine performed by wound healing clinicians working in a network setting offered a safe option to remotely manage comorbid, complex wound care patients with reduced mobility.

DİYABETİK AYAK ÜLSERİNDE FİZİKSEL MUAYENE VE HEMŞİRELİK BAKIMI

Bu derlemede, diyabetik ayak ülserli hastalarda hemşirenin ayak muayenesi yapmasının önemi, ayağın fiziksel muayenesi ve diyabetik ayak ülserinin Wagner’a göre sınıflandırılarak yapılan bakımı üzerinde durulmuştur. Diyabetli bireyin ayaklarının ayrıntılı muayenesi, ayaktaki risk durumunun belirlenmesi, oluşabilecek ülserler ve var olan ülserin tedavisi için oldukça önemlidir. Ayağın fizik muayenesinde periferal nöropati, periferik arter hastalığı ve ülser gelişimine neden olan ayak deformiteleri, ülserin lokalizasyonunu, ülserin evresi, enfeksiyon varlığı, yürüme özellikleri değerlendirilir. Diyabet süresinin artması ile diyabetik ayak ülseri oluşma riski arttığı ve bir kez ülser oluştuktan sonra tekrarlama oranı yüksek olduğu için hemşire, diyabetik ayak ülserini oluşturan risk faktörlerini bilmeli ve bu risk faktörleri ile birlikte ayağı değerlendirmelidir. Diyabetik ayak ülserlerinde bakımın amacı, doku bütünlüğünün korunması, yeni yara oluşumunun engellenmesi, daha fazla doku yıkımı ve enfeksiyon gelişiminin önlenmesi ve yara bakımının sağlanmasıdır.

Three Wound Care Quality Performance Measures Are Now Public: Why It Matters

Three Wound Care Quality Performance Measures Are Now Public: Why It Matters

Diabetic Foot Ulcer Treatment Post AutoAmputation Digiti Pedis Sinistra: Case Study

Latar Belakang : Diabetes Melitus (DM) adalah penyakit kronis serius yang terjadi ketika pankreas tidak menghasilkan cukup insulin (hormon yang mengatur glukosa darah), atau ketika tubuh tidak dapat secara efektif menggunakan insulin yang dihasilkannya. Menurut International Diabetes Federation, terdapat 425 juta orang yang menderita diabetes di dunia dan akan meningkat sebesar 629 juta orang pada tahun 2045. Terdapat lebih dari 10.276.100 kasus diabetes di Indonesia pada tahun 2017 dari total populasi dewasa sebesar 166.531.000 yang berarti terdapat prevalensi penderita diabetes sebesar 6,7% dan menduduki peringkat 6 dari 10 negara teratas untuk jumlah penderita diabetes. Penderita diabetes memiliki peningkatan risiko sejumlah masalah kesehatan yang serius. Banyak yang mengeluhkan terjadinya ulkus diabetik yaitu luka terbuka pada penderita DM sehingga diabetes melitus menjadi penyebab terjadinya amputasi kaki pada penderita DM. Amputasi terjadi 15 kali lebih sering pada penderita diabetes daripada non diabetes. Pada tahun 2032, seiring dengan peningkatan jumlah penyandang diabetes di dunia, terjadi peningkatan kaki diabetik. Perawatan kaki yang dilakukan secara efektif dapat mencegah resiko ulkus menjadi amputasi. Dengan dilakukan manajemen yang komprehensif, sebagian besar amputasi yang berkaitan dengan diabetes dapat dicegah. Bahkan ketika amputasi berlangsung, kaki yang tersisa dan kehidupan orang tersebut dapat diselamatkan dengan perawatan tindak lanjut yang baik.Tujuan : Untuk memberikan gambaran perawatan luka serta menilai proses perawatan dan perkembangan luka kaki diabetes pada pasien diabetes melitus selama 5 minggu perawatan.Metode : penelitian ini merupakan jenis penelitian yang dilakukan secara prospektif yang dimulai dari tanggal 10 September – 9 Oktober 2018 di Klinik Perawatan Luka Griya Afiat, Makassar. Status Demografi dan pengkajian luka didapatkan melalui wawancara langsung kepada pasien dan keluarga serta menilai luka menggunakan format Asuhan Keperawatan Luka dari Klinik Griya Afiat.Hasil : Pada minggu pertama perawatan, Keadaan luka memiliki banyak undermining. Berdasarkan struktur lapisan kulit, luka berada pada full thickness. Penampilan klinis lain ditemukan adanya slough/infeksi, disertai odor, kulit sekitar luka mengalami maserasi, serta edema. Teknik debridemen yang digunakan yaitu Conservatif Sharp Wound Debridement (CSWD) dan autolysis. Dressing yang digunakan pada perawatan luka yaitu hidrofobik dan salep zink sebagai dressing primer, kasa steril dan diaper sebagai balutan sekunder, serta kasa gulung sebagai balutan tersier. Untuk perawatan periwound digunkan salep zink. Terjadi perubahan ukuran yang berbeda-beda pada tiap luka dan meningkatnya proses granulasi dan epitelisasi tiap minggu perawatan hingga minggu kelima perawatan, keadaan luka mulai mengalami peningkatan epitelisasi dan mengalami perubahan ukuran luka terutama pada undermining, presentasi slough menurun, tanda infeksi lokal mulai berkurang.Kesimpulan : Selama proses perawatan luka selama 5 minggu, Proses penyembuhan luka mengalami progress yang baik. Pada minggu pertama dan kedua mengalami fase inflamasi, pada minggu ketiga hingga kelima mengalami proses poliferasi. waktu proses penyembuhan luka berjalan lambat, terjadi perubahan ukuran dan kedalaman yang berbeda-beda pada beberapa luka di setiap minggu perawatan, luka tidak berpotensi amputasi dengan tidak terdapatnya luka nekrotik selama 5 minggu perawatan, tanda-tanda infeksi lokal pada luka semakin berkurang di setiap minggu perawatan, terdapat edema pada kaki kiri yang mengalami luka diabetik serta kaki kanan sehingga diperlukan pemeriksaan lebih lanjut untuk mengatasi faktor lain yang menghambat proses penyembuhan.Keywords : Diabetes Milletus, Luka Kaki Diabetes, Post Autoamputasi.

Update on Collagens: What You Need to Know and Consider.

The prevalence of chronic wounds remains a concern for wound care providers. Additional therapies that promote wound healing continue to be on the forefront of wound care. Selecting treatment modalities should be based on current evidence and a critical analysis of that evidence. However, evidence in wound care in the form of randomized controlled trials is lacking. This article describes collagen, its use in wound care, and current evidence for review.

Injectable alginate fibrous hydrogel with a three-dimensional network structure fabricated by microfluidic spinning

Abstract Several new types of medical dressings have been developed thus far. However, most are two-dimensional membrane dressings which cannot be used to dress wounds of certain depths such as chronic ulcers and bedsores, and hence, cannot provide wound care. In this work, calcium alginate (Ca-Alg)–polyethylene glycol dipropylene ester (PEGDA) fibers and an injectable fibrous hydrogel were fabricated by microfluidic spinning. The morphology and diameter of the fibers were observed using a fluorescence inverted microscope and scanning electron microscope. The swelling properties under different conditions of the Ca-Alg–PEGDA fibrous hydrogels were tested at room temperature. The results showed that the fibers were arranged in orientation after injection. The diameters of the Ca-Alg–PEGDA fibers decreased with decreasing sodium alginate content. The swelling rate of the Ca-Alg–PEGDA fibrous hydrogels first increased and then decreased with increasing PEGDA content. The injectable Ca-Alg–PEGDA fibrous hydrogel has a three-dimensional network microstructure , which will be useful for filling and treating wounds of a certain depth, and potentially even for shortening the wound healing cycle.

Community nursing care for chronic wounds: a case study of optimal home treatment of a venous leg ulcer

Europe's aging population presents an increasing number of chronic diseases, including vascular diseases that can lead to chronic wounds. These chronic wounds carry a significant health burden for individuals and economic burden for healthcare systems. Of chronic ulcers in the lower limbs, 80–85% are venous leg ulcers (VLUs). VLUs can be treated using a combination of compression therapy, modern wound dressings and wound-bed preparation based on tissue management, inflammation and infection control, moisture balance and epithelial advancement. This approach should improve the patient's quality of life in a way that is fast, cost-effective and minimises pain. Optimal treatment should involve holistic, comprehensive care for the individual patient, supported by multidisciplinary teamwork and patient education for self-care. An aging population also increases the need for community nursing care in patients' homes. Access to home wound care differs between European countries, particularly whether it is provided by registered nurses, as part of the healthcare system, or by homecare assistants, as part of the social care system. In countries like Slovenia, community nurses play an important role in the multidisciplinary treatment of VLUs, as they care for patients in the home environment and can best assess their condition. The GP first makes the initial wound assessment and diagnosis before authorising the community nurse to provide wound care in the patient's home. A case study is presented of a 91-year-old male patient with a VLU, alongside reduced mobility and multiple comorbidities. The treatment method provided optimal healing and is described and illustrated in detail.

Disposable Patterned Electroceutical Dressing (PED-10) Is Safe for Treatment of Open Clinical Chronic Wounds.

Objective: To evaluate if patterned electroceutical dressing (PED) is safe for human chronic wounds treatment as reported by wound care providers. Approach: This work reports a pilot feasibility study with the primary objective to determine physically observable effects of PED application on host tissue response from a safety evaluation point of view. For this pilot study, patients receiving a lower extremity amputation with at least one open wound on the part to be amputated were enrolled. Patients were identified through the Ohio State University Wexner Medical Center (OSUWMC) based on inclusion and exclusion criteria through prescreening through the Comprehensive Wound Center's (CWC) Limb Preservation Program and wound physicians and/or providers at OSUWMC. Wounds were treated with the PED before amputation surgery. Results: The intent of the study was to identify if PED was safe for clinical application based on visual observations of adverse or lack of adverse events on skin and wound tissue. The pilot testing performed on a small cohort (N = 8) of patients showed that with engineered voltage regulation of current flow to the open wound, the PED can be used with little to no visually observable adverse effects on chronic human skin wounds. Innovation: The PED was developed as a second-generation tunable electroceutical wound care dressing, which could potentially be used to treat wounds with deeper infections compared with current state of the art that treats wounds with treatment zone limited to the surface near topical application. Conclusion: Technology advances in design and fabrication of electroceutical dressings were leveraged to develop a tunable laboratory prototype that could be used as a disposable low-cost electroceutical wound care dressing on chronic wounds. Design revisions of PED-1 (1 kΩ ballast resistor) circumvented previously observed adverse effects on the skin in the vicinity of an open wound. PED-10 (including a 10 kΩ ballast resistor) was well tolerated in the small cohort of patients (N = 8) on whom it was tested, and the observations reported here warrant a larger study to determine the clinical impact on human wound healing and infection control.

Implementation of Interdisciplinary Wound Care Rounds in a Skilled Nursing Facility

There is scant literature regarding interdisciplinary teams providing wound care in long-term care. Our long-term care facility did not have a consistent process for evaluation and treatment of wounds by nursing and physician teams.

Pressure Injury Education in the Department of Veterans Affairs

The aim of this study was to describe experience, training, educational needs and preferences, and perceptions of pressure injury (PI) prevention education of wound care providers in the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) as an indicator of effectiveness of the mandated VHA PI Prevention Program. A convenience sample of national VHA wound care providers practicing in VHA facilities was compiled from members of special interest groups and committees and by referrals from known wound care specialists and clinicians (N = 1726). The response rate was 24% (n = 410). Cross-sectional, descriptive study. A 42-item online cross-sectional survey was administered via a blast-email of the survey link to the sample. The survey link was active for 1 month (March 3-31, 2014). The survey queried demographic data, PI experience and education, and their perceptions and preferences for PI education. Quantitative responses underwent descriptive analyses, and responses to open-ended questions were analyzed by content analysis. The majority of the 415 respondents completed most of the questionnaire (n = 310, 74%). Half were board-certified providers with a mean wound care experience of 14.2 years (standard deviation = 9.8 years). Preference for type of wound training ranged from 17% for online gaming to 82% for face-to-face training. Training provided by facilities was perceived to be inadequate for wound care by 60% (n = 175) and inadequate for PI care by 49% (n = 142). The 2 greatest areas of need in PI care identified by wound care providers were education and documentation. These same issues were identified as problematic by an audit of PI prevention and management at 47 VHA facilities that was conducted by the VA Office of Inspector General.

Development of Low-Cost Locally Sourced Two-Component Compression Bandages in Western Kenya.

IntroductionCompression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities. When wound care providers from an Academic Model Providing Access to Healthcare (AMPATH) health center in Western Kenya noted that a donated, finite supply of two-component compression bandages was helping to heal chronic leg ulcers, they began to explore the potential of finding a local, sustainable solution. Dermatology and pharmacy teams from AMPATH collaborated with health center providers to address this need.MethodsFollowing a literature review and examination of ingredients in prepackaged brand-name kits, essential components were identified: elastic crepe, gauze, and zinc oxide paste. All of these materials are locally available and routinely used for wound care. Two-component compression bandages were made by applying zinc oxide to dry gauze for the inner layer and using elastic crepe as the outer layer. Feedback from wound clinic providers was utilized to optimize the compression bandages for ease of use.ResultsAdjustments to assembly of the paste bandage included use of zinc oxide paste instead of zinc oxide ointment for easier gauze impregnation and cutting the inner layer gauze in half lengthwise to facilitate easier bandaging of the leg, such that there were two rolls of zinc-impregnated gauze each measuring 5 inches × 2 m. Adjustments to use of the compression bandage have included increasing the frequency of bandage changes from 7 to 3 days during the rainy seasons, when it is difficult to keep the bandage dry. Continuous local acquisition of all components led to lower price quotes for bulk materials, driving down the production cost and enabling a cost to the patient of 200 KSh (2 USD) per two-component compression bandage kit. Wound care providers have provided anecdotal reports of healed chronic leg ulcers (from venous stasis, trauma), improved lymphedema, and patient tolerance of compression.ConclusionsLow-cost locally sourced two-component compression bandages have been developed for use in Western Kenya. Their use has been initiated at an AMPATH health center and is poised to meet the need for affordable compression therapy options in Western Kenya. Studies evaluating their efficacy in chronic leg ulcers and Kaposi sarcoma lymphedema are ongoing. Future work should address adaptation of compression bandages for optimal use in Western Kenya and evaluate reproducibility of these bandages in similar settings, as well as consider home- or community-based care delivery models to mitigate transportation costs associated with accessing healthcare facilities.

279 Costs of Burn Wound Care in a Resource-poor Setting

A collaboration between a high income (HIC) and a low income (LIC) country medical centers with grant funding over three years resulted in the establishment of a pediatric burn unit. Burn wound care prior to the three-year grant period was the open desiccation method, incurring little to no cost. Wound care was transitioned to the closed method with burn ointment, cream, and bandages through the grant funding. In the post grant period following the loss of funding, the burn center must attempt to cost share with the hospital and families for the funds necessary to maintain the practice change. This has proven challenging in a LIC setting. Sustainable development of burn care in a LIC requires a more cost-effective alternative to the open method. Throughout the three-year grant period, a financial spreadsheet was maintained on a Google platform with all costs, including funds required for dressing supplies. Following the grant period, a cost analysis was conducted by the team working in the new burn center to assess the funds necessary to maintain the standard of care established during the grant period. During the three-year granting period $16,993.64 was spent on wound care supplies for 673 children treated, $25.25 per child. Evaluation in the post grant period with concerted efforts to cut cost while maintaining the standard of care resulted in an expected need of $21.76 per child. The average census of 20 children equates to an estimated $5,222.43 annually to provide wound care for an expected 240 children. In contrast, the open method required only a reusable cage and common clean cloth from the family. A pediatric burn center was organized in a low resource setting. As part of the process topical wound care cost were raised from essentially free to more than $25.25 per child. This financial challenge has proven difficult to maintain and it may be inevitable that the open desiccation method of wound care returns for some children. More research is needed on cost-effective alternatives for wound care in LIC’s that have the benefits of the closed method and multiday dressings (MDD) used in HIC. MDD and adherent “skin” like dressings should be considered despite the increased cost as they may allow outpatient management, reducing the global economic burden on the family and society. The best economic solution for wound care in the LIC needs to be characterized and become a priority for national ministries of health and The World Health Organization if progress is to be made on burn wound care in the poorest parts of our world. Directly Applicable.

SUDDEN DEATH Triathlons more risky for men than marathons

SUDDEN DEATH Triathlons more risky for men than marathons

A Wearable Electrochemical Sensor to Monitor Progression of Wound Healing

An enzymatic electrochemical biosensor comprising the enzyme, urate oxidase (uricase, UOx), has been investigated for detection of real-time changes in uric acid. Uric acid (UA) is a key biomarker for monitoring severity of wounds, a complex process initiated to restore tissue damage. With its presence in different bio-fluids, this work explores possibilities of continuous, non-invasive detection of systemic UA levels. Here, hydrolysis of UA was explored to detect the oxidation of its byproduct, H2O2. The role of metal nano-particles was investigated on detection, through cyclic voltammetry. Use of a redox electron shuttle, ferrocene carboxylic acid (FCA), was seen to enable electron transfer between the active site of the enzyme and the electrode. The constructed enzymatic uric acid biosensor provided a sensitivity of 0.14 µA µM-1 cm-2 and detection limit of 14µM within the physiologically relevant range. This biosensor has the potential of providing wound care through continual systemic UA monitoring.

An improved automated type‐based method for area assessment of wound surface

Accurate and precise wound measurements are a critical component of wound detection and assessment. Digital cameras are convenient and objective tools that are being increasingly used worldwide to assist with wound measurements and assessments. However, heterogeneous wounds and poor lighting conditions continue to be obstacles to wound area recognition. This study, therefore, provides an improved automated type-based wound area assessment method that is robust to lighting conditions and can distinguish between different wound tissues based on wound colors. The results of both laboratory and clinical applications of the proposed method show excellent consistency of manual area measurements. This proposed technology is expected to provide wound care specialists with more clinical information about heterogeneous wounds, thereby enabling prospective cost savings for therapy and treatment.