Wound Photography Research Articles

Results of the Phase 1 Open-Label Safety Study of Umbilical Cord Lining Mesenchymal Stromal/Stem Cells (Corlicyte®) to Heal Chronic Diabetic Foot Ulcers.

Mesenchymal stromal/stem cells (MSCs) play a critical role in wound healing. Corlicyte® is an MSC product derived from allogeneic umbilical cord tissue donated under an institutional review board-approved protocol and processed in accordance with section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act. This open-label phase 1 trial was performed under a United States Food and Drug Administration Investigational New Drug Application to establish the safety and tolerability of Corlicyte® in patients with diabetes and chronic diabetic foot ulcer (DFU). Escalating doses were applied topically twice a week for up to 8 weeks after ulcer debridement, wound photography, and measurement. Subjects were followed for 4 weeks after the treatment phase. Adverse events were assessed at every visit. Nine subjects in 2 dosing cohorts completed the trial. No subjects experienced a serious adverse reaction to Corlicyte® or the development of anti-human leukocyte antigen (HLA) antibodies. Sixty percentage of subjects in the lower dose cohort experienced ulcer closure by Day 70 of follow-up, while the mean ulcer size was reduced by 54-67% in the other subjects. Topical administration of Corlicyte®, a novel biologic therapy consisting of allogeneic umbilical cord lining MSCs, appeared safe and tolerable and resulted in a significant decrease in ulcer area, demonstrating its potential as a therapy for healing of chronic DFU.

Wound management across Australian and New Zealand pediatric cardiac services: a cross-sectional survey.

CHD is associated with considerable burden of care. Up to one-third of babies born with CHD require surgery or intervention during the first year of life with an associated increased risk of surgical site infection. Pediatric wound care is informed largely by adult data, with no national or international guidelines available. To examine pediatric cardiac surgical wound care practices reported by healthcare professionals Australia and New Zealand-wide. A bi-national cross-sectional survey exploring pre-, intra- and post-operative wound practices was distributed using Exponential Non-Discriminative Snowball Sampling. Data were subject to descriptive analysis using SPSS Statistics 22.0. Sixty-eight surveys representing all Australian and New Zealand pediatric cardiac surgical services were analyzed. Most respondents were experienced nurses. Pre-operative care varied greatly in practice and pharmaceutical agents used. Little consistency was reported for intra- and post-operative wound care. Nursing and medical staff shared responsibility for wound care. Wound photography was widely used, but only uploaded to electronic medical records by some. These results highlight that wound care management is largely informed at an institutional level. The many practices reported are likely to reflect a range of factors including cardiac condition complexity, surgery, prematurity, and the presence of scar tissue. The importance of a research and training program, which is multimodal, available, and reflective, is highlighted. These findings call for the establishment of a nurse-led program of research and education. The resultant suite of cardiac wound strategies could offer an effective and consistent pathway forward.

Is my wound infected? A study on the use of hyperspectral imaging to assess wound infection.

Clinical signs and symptoms (CSS) of infection are a standard part of wound care, yet they can have low specificity and sensitivity, which can further vary due to clinician knowledge, experience, and education. Wound photography is becoming more widely adopted to support wound care. Thermography has been studied in the medical literature to assess signs of perfusion and inflammation for decades. Bacterial fluorescence has recently emerged as a valuable tool to detect a high bacterial load within wounds. Combining these modalities offers a potential objective screening tool for wound infection. A multi-center prospective study of 66 outpatient wound care patients used hyperspectral imaging to collect visible light, thermography, and bacterial fluorescence images. Wounds were assessed and screened using the International Wound Infection Institute (IWII) checklist for CSS of infection. Principal component analysis was performed on the images to identify wounds presenting as infected, inflamed, or non-infected. The model could accurately predict all three wound classes (infected, inflamed, and non-infected) with an accuracy of 74%. They performed best on infected wounds (100% sensitivity and 91% specificity) compared to non-inflamed (sensitivity 94%, specificity 70%) and inflamed wounds (85% sensitivity, 77% specificity). Combining multiple imaging modalities enables the application of models to improve wound assessment. Infection detection by CSS is vulnerable to subjective interpretation and variability based on clinicians' education and skills. Enabling clinicians to use point-of-care hyperspectral imaging may allow earlier infection detection and intervention, possibly preventing delays in wound healing and minimizing adverse events.

Remote assessment of surgical site infection (SSI) using patient-taken wound images: Development and evaluation of a method for research and routine practice

Background/aimClinical assessment of wounds for surgical site infection (SSI) after hospital discharge is challenging and resource intensive. Remote assessment using digital images may be feasible and expedite SSI diagnosis. Acceptable and accurate methods for this process are needed. This study developed and evaluated the feasibility, acceptability and usability of a method for patients to capture standardised wound images for remote wound assessment to detect SSI. Materials and methodsThe work was conducted in two phases. Phase I involved: i) a review of literature to identify key components of photography relevant to taking wound images, ii) development of wound photography instructions for patients and a secure process for transmission of images using electronic survey software and iii) pre-testing of the photography instructions and processing method with a sample of 16 patients using cognitive interviews and observations. Phase II involved a prospective cohort study of 89 patients to evaluate the feasibility, acceptability and usability of the remote method following discharge from hospital after surgery. Quality of the images was assessed by three independent clinical reviewers. ResultsSome 21 key components for photographing wounds were identified from 11 documents. Of these, 16 were relevant to include in instructions for patients to photograph their wounds. Pre-testing and subsequent iterations improved understanding and ease of use of the instructions and the process for transmitting images. Fifty-two of 89 (58.4%) patients testing the method remotely took an image of their wound(s) and 46/52 (88.5%) successfully transmitted images. When it was possible to ascertain a reason for not taking/transmitting images, this was primarily health problems (n = 7) or lack of time/poor engagement with the study (n = 4) rather than problems relating to technology/competency (n = 2) or practical issues relating to the wound itself (n = 2). Eighty-seven (85.3%) of the 102 images received were evaluated to be of high quality and sufficient to remotely assess SSI by at least two independent reviewers. ConclusionA simple, standardised and acceptable method for patients to take and transmit wound images suitable for remote assessment of SSI has been developed and tested and is now available for use in routine clinical care and research.

The effectiveness of advanced practice registered nurses with wound care specialization in the home setting on wound resolution and healthcare utilizationhe Home Setting on Wound Resolution and Healthcare Utilization

Objective: The purpose of this study was to evaluate the effectiveness of advanced practice registered nurses (APRNs) with wound specialization on wound resolution and healthcare (HC) utilization for home health patients.Methods: A quasi-experimental design with a convenience sample of 30 participants admitted to home health (HH) services compared to a retrospective chart review of 46 participants matched in terms of volume, wound type, wound size, gender, and age was used during the study. The APRN conducted a physical exam and history, obtained wound photography, developed a treatment plan, performed therapy, wrote orders for products and services, and provided a minimum of weekly follow-up visits. Healthcare utilization comprised time for healing, admits to a higher level of care, and amputations. Wound resolution was observed at 80% and 100% closure.Results: The Intervention and Control Groups were comparable in terms of gender, wound type, age, and acuity, were similar regarding wounds per patient. Both groups achieved 80% volume, 80% area, and 100% wound resolution, regardless of wound types. The Intervention Group’s days to wound resolution was statistically significant for fewer days than the Control Group. This difference persisted after analysis of wound types within the groups. The Intervention Group had fewer acute care admits (10%) compared to the Control Group (50%), and the number of amputations was higher in the Control Group, with six amputations compared to only one in the Intervention Group.Conclusions: Using APRNs with wound specialization improved patient outcomes, efficiency, and costs. The program should be evaluated for adoption and expansion. Further research into the impact of wound-specialized APRNs in the home setting is recommended.

Capturing Essentials in Wound Photography Past, Present, and Future: A Proposed Algorithm for Standardization.

To discuss a standardized methodology for wound photography with a focus on aiding clinicians in capturing high-fidelity images. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will be able to:1. Discriminate the components of high-quality wound photography.2. Identify the technological innovations that can augment clinical decision-making capacity.3. Choose strategies that can help clinicians avoid adverse medicolegal outcomes.

Capturing essentials in wound photography past, present, and future: A proposed algorithm for standardization.

In Brief Photographic documentation is indispensable in the management of chronic wounds. This article elaborates a standardized methodology for wound photography and aids clinicians in capturing consistent, high-fidelity images.

Capturing essentials in wound photography past, present, and future: A proposed algorithm for standardization.

Capturing essentials in wound photography past, present, and future: A proposed algorithm for standardization.

Capturing Essentials in Wound Photography Past, Present, and Future: A Proposed Algorithm for Standardization.

Capturing Essentials in Wound Photography Past, Present, and Future: A Proposed Algorithm for Standardization.

Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma.

Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J2021;103-B(12):1802-1808.

The disproportionate burden of electronic health record messages with image attachments in dermatology

To the Editor: Clinicians face an increasing burden of electronic health record (EHR) notifications.1Murphy D.R. Meyer A.N. Russo E. Sittig D.F. Wei L. Singh H. The burden of inbox notifications in commercial electronic health records.JAMA Intern Med. 2016; 176: 559-560https://doi.org/10.1001/jamainternmed.2016.0209Crossref PubMed Scopus (64) Google Scholar Dermatologists may receive 50 EHR messages per day, associated with increasing burnout symptoms.2Bittar P.G. Nicholas M.W. The burden of inbox-messaging systems and its effect on work-life balance in dermatology.J Am Acad Dermatol. 2018; 79: 361-363.e1https://doi.org/10.1016/j.jaad.2017.12.026Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Recently, health care systems have enabled patients to send unsolicited images to their physicians within patient-generated messages (PGMs). Although patient-generated images may reduce the overtreatment of surgical site infections, to our knowledge, no study has evaluated the role of patient-generated images in dermatology.3Kummerow Broman K. Gaskill C.E. Faqih A. et al.Evaluation of wound photography for remote postoperative assessment of surgical site infections.JAMA Surg. 2019; 154: 117-124https://doi.org/10.1001/jamasurg.2018.3861Crossref PubMed Scopus (21) Google Scholar We sought to characterize the burden of patient-generated imaging sent to Duke University Health System (DUHS) and Duke Dermatology between 2017 and 2019. We retrieved EHR logs of PGMs sent to DUHS from August 21, 2017, to August 20, 2018, before attachment functionality (preimage period), and from August 21, 2018, to August 20, 2019, after attachments were enabled (postimage period). We used the chi-square test to compare image message burden, the Wilcoxon rank sum test to compare reply time, and a paired t test for mean burnout scores and considered P < .05 significant, assuming that each message was an independent observation. We distributed a survey on message behavior and burnout in 2017 and in 2021, adapted from the validated Maslach Burnout Inventory.4Maslach C. Jackson S.E. Leiter M.P. Schaufeli W.B. Schwab R.L. Maslach Burnout Inventory Manual. Consulting Psychologists Press, 1986Google Scholar,5Sexton J.B. Adair K.C. Leonard M.W. et al.Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.BMJ Qual Saf. 2018; 27: 261-270https://doi.org/10.1136/bmjqs-2016-006399Crossref PubMed Scopus (75) Google Scholar In total, 1,056,169 and 1,346,444 PGMs, respectively, were sent in the preimage and postimage periods, including 14,079 and 19,450 messages sent to dermatology. PGMs increased in the postimage period by 5.4 messages per 100 arrived visits in nondermatology departments and 7.8 messages per 100 arrived visits in dermatology departments (Fig 1). The proportion of messages in the postimage period with image attachments was significantly higher in dermatology (n = 2797, 14.4%) than in nondermatology departments (n = 45,444, 3.4%; Fig 2; P < .05). In Duke Dermatology, the message reply times were significantly shorter in the postimage period (median, 13.3 hours; interquartile range, 2.3-28.9 hours) than in the preimage period (median, 16.5 hours; interquartile range, 2.7-43.5 hours; P < .05).Fig 2Proportion of patient-generated messages with picture attachments.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Twenty-seven (77%) clinicians responded to the 2021 survey (Supplemental Material available via Mendeley at https://data.mendeley.com/datasets/t7cbvvdw46/1). Almost all clinicians (93%) agreed that the EHR messages benefit patient communication; however, only 44% of clinicians agreed that attachments benefit patient care. Clinicians also reported that messages with images increased workload (mean, 3.4/4; range, strongly disagree to strongly agree). Compared with an identical burnout survey distributed in 2017, the mean burnout scores for all clinicians were not significantly different; however, for 8 clinicians with responses in 2017 and 2021, the burnout scores (range, 10-50) increased from a mean of 32 to 39 (P < .05). We analyzed more than 2 million PGMs sent to DUHS between 2017 and 2019. PGMs per arrived visit increased in all departments, but Duke Dermatology bore a disproportionate burden of PGMs with attachments, resulting in a high level of uncompensated work. Assuming a reimbursement of $40 per image, the first year post go-live resulted in a revenue loss of $112,000. Given this burden, dermatology departments should be involved in the health care system decision-making around image messaging. Additionally, messages with images may take more clinician time to address, with complicated medical decision-making, and there is little evidence regarding their clinical utility. Taken together, these issues likely contribute to increasing clinician fatigue and burnout. Further research must address the clinical utility of PGMs with image attachments, as well as the effects of the large burden of image messages sent to dermatologists. None disclosed.

Treating hard-to-heal ulcers: biocellulose with nanosilver compared with silver sulfadiazine.

Controlling infection and promoting healing should be the aims of hard-to-heal diabetic ulcer treatment, along with improving a patient's general condition and their blood sugar control. Many hard-to-heal diabetic ulcers present with cavities, tracks or a combination of these. There is a new biocellulose (with a nanosilver dressing) which has the ability to contour around and conform to the irregular surface of a wound bed. The purpose of this study was to evaluate its efficacy compared with a silver sulfadiazine cream, for hard-to-heal diabetic ulcer treatment. In this randomised control trial, patients with hard-to-heal diabetic ulcers were divided into two equal-sized groups: treatment with the biocellulose with blue nanosilver (experimental group), and treatment with silver sulfadiazine cream group (control group). Cotton gauze was used as the secondary dressing for both groups. Demographic data, wound size, wound classification, wound photography and bacterial cultures were recorded at the beginning of the study. Wounds were debrided as necessary. Dressings were changed twice daily in the control group, and every three days in the experimental group. A total of 20 patients took part in the study (10 patients in each group). The highest mean wound healing rates were 91.4% in the experimental group and 83.9% in the control group. No wound infections or adverse effects from the dressings were detected in either group. In this study, biocellulose with blue nanosilver adapted well to the wound bed. Wound reduction was greater in the experimental group than the control group. Biocellulose with blue nanosilver could therefore be a good choice for hard-to-heal diabetic ulcer treatment, due to its good healing rates and minimal care requirements.

25-Hydroxyvitamin D Deficiency: Impacting Deep-Wound Infection and Poor Healing Outcomes in Patients With Diabetes

The Kingdom of Bahrain has a high incidence of diabetes and associated foot complications. Simultaneously, low 25-hydroxyvitamin D (25[OH]D) levels are common in this population and may be associated with the traditional clothing used in desert climates. This investigation compared 25(OH)D levels and glycemic control with quantifiable wound healing parameters in a prospective, analytic, nonexperimental, cross-sectional pilot study. Consecutive consenting adult patients (N = 80) who presented to the regional wound care unit in January 2016 with either an existing or new wound were included. Collected data included three-dimensional wound photography, NERDS and STONEES criteria, and an X-ray with a positive probe-to-bone test. Blood values for 25(OH)D and hemoglobin A1c (HbA1c) were collected simultaneously. Diabetes mellitus (types 1 and 2) was present in 90% of the sample patients. No patient had sufficient 25(OH)D levels; 15% had insufficient levels (30-50 ng/mL), and deficiency (levels <#20 ng/mL) was found in 85% of the sample. Males were slightly less affected by 25(OH)D deficiency compared with females (82.4% vs 91.3%). Poor glycemic control (HbA1c levels >#6.8%) was found in 69.4% (n = 50) of the persons with diabetes included in the sample. Those with both diabetes mellitus and a 25(OH)D deficiency (76.3%; n = 61) were more likely to demonstrate healing difficulty (40.9%; n = 25) or present with a stalled or deteriorating wound (44.2%, n = 27). A 3° F or higher periwound surface temperature elevation over a mirror image site was present in 82.5% of all wounds. Exposed bone in the ulcer base was found in 50% of the cases. For persons with diabetes, general linear modeling statistical analysis (adjusted R value = 47.9%) linked poor wound healing with three studied variables: 25(OH)D deficiency, poor glycemic control, and an exposed bone in the wound bed. Vitamin D may be an overlooked factor in the pathophysiology of diabetic foot ulcer development and subsequent delay in wound healing outcomes. The authors recommend adding 25(OH)D deficiency to the list of multifactorial aggravating factors providers should consider correcting in this subgroup of patients.

Evaluation of Wound Photography for Remote Postoperative Assessment of Surgical Site Infections

ImportanceSurgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. Early work using remote care to diagnose surgical site infections (SSIs) demonstrated improved diagnostic accuracy using wound photographs to augment patients’ electronic reports of symptoms, but it is unclear whether these findings are reproducible in real-world practice.ObjectiveTo determine how wound photography affects surgeons’ abilities to diagnose SSIs in a pragmatic setting.Design, Setting, and ParticipantsThis prospective study compared surgeons’ paired assessments of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs. Data for case vignettes were collected prospectively from May 1, 2007, to January 31, 2009, at Erasmus University Medical Center, Rotterdam, the Netherlands, and from July 1, 2015, to February 29, 2016, at Vanderbilt University Medical Center, Nashville, Tennessee. The surgeons were members of the American Medical Association whose self-designated specialty is general, abdominal, colorectal, oncologic, or vascular surgery and who completed internet-based assessments from May 21 to June 10, 2016.InterventionSurgeons reviewed online clinical vignettes with or without wound photography.Main Outcomes and MeasuresSurgeons’ diagnostic accuracy, sensitivity, specificity, confidence, and proposed management with respect to SSIs.ResultsA total of 523 surgeons (113 women and 410 men; mean [SD] age, 53 [10] years) completed a mean of 2.9 clinical vignettes. For the diagnosis of SSIs, the addition of wound photography did not change accuracy (863 of 1512 [57.1%] without and 878 of 1512 [58.1%] with photographs). Photographs decreased sensitivity (from 0.58 to 0.50) but increased specificity (from 0.56 to 0.63). In 415 of 1512 cases (27.4%), the addition of wound photography changed the surgeons’ assessment (215 of 1512 [14.2%] changed from incorrect to correct and 200 of 1512 [13.2%] changed from correct to incorrect). Surgeons reported greater confidence when vignettes included a wound photograph compared with vignettes without a wound photograph, regardless of whether they correctly identified an SSI (median, 8 [interquartile range, 6-9] vs median, 8 [interquartile range, 7-9]; P < .001) but they were more likely to undertriage patients when vignettes included a wound photograph, regardless of whether they correctly identified an SSI.Conclusions and RelevanceIn a practical simulation, wound photography increased specificity and surgeon confidence, but worsened sensitivity for detection of SSIs. Remote evaluation of patient-generated wound photographs may not accurately reflect the clinical state of surgical incisions. Effective widespread implementation of remote postoperative assessment with photography may require additional development of tools, participant training, and mechanisms to verify image quality.

The characteristics of pressure injury photographs from the electronic health record in clinical settings.

To analyse and understand the characteristics of pressure injury images stored in the electronic health record. To improve the quality of pressure injury documentation, photographing pressure injuries and storing the images in the electronic health record are standard practices in many hospitals. As new technologies develop, the utilisation of computer-assisted image processing makes automatic measurement of pressure injury size and tissue segmentation through pressure injury images possible. The translation of new technological developments to pressure injury photography conducted in clinical environments faces obstacles such as the complexity of conditions in which photographs are taken. A cross-sectional descriptive study. A set of 360 pressure injury images were obtained from a hospital in western Pennsylvania. These images were taken in clinical settings during daily wound care service. The authors reviewed the pressure injury images to analyse the relative position of the pressure injury in the images, the shooting angle of the digital camera and the clinical objects in the background. Only 5.9% of the pressure injury images were confined to only the wound region. In 80.1% of the images, the pressure injury is located in the central part of the image. In 54.0% of the images, the lens of the digital camera was not pointed perpendicularly to the plane of the pressure injury. Bedside wound assessment of pressure injuries and assessment from photographs of pressure injuries display reasonable agreement with pressure injury staging. To extract wound information (e.g., size and tissue type) from pressure injury images through novel image processing technologies, the characteristics of pressure injury images in clinical settings should be better understood during the development of tools for pressure injury image processing. Our results can help image processing experts understand wound photography characteristics to shorten the gap between laboratory and clinical environments when translating new image processing technologies.

My wound and I: patients’ perspective

Clinical photography is beneficial to clinicians and healthcare teams in the care of patients and wound management. The aim of this study was to investigate patients’ perspective of wound photography in an NHS hospital outpatient clinic, assessing its personal benefits and wider applications. Patients were asked to participate in a questionnaire, to identify information about their wound(s), investigate their perspective of the benefits and uses of wound photography, as well as their preference regarding imaging operators and devices. Results showed that all participants thought that clinical images offer a more comprehensive record of their wound when used in conjunction with measurements and written descriptions. The majority of patients considered wound photography of benefit to them, to monitor their healing and they also appreciated the wider uses of these images. Clinical photographers were the preferred choice as the image operator, whereas the preference for the imaging device used was not as significant. In conclusion, participants considered wound photography to be beneficial for personal and broader purposes, with the current clinical photography service being rated highly. These findings give an insight into the patients’ perspective of wound photography, which can be useful when developing and delivering services within the NHS.

A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns.

Research suggests that active Leptospermum honey (ALH) improves outcomes in patients with partial-thickness burns by enhancing healing and reepithelialization rates, as well as by protecting against antibiotic-resistant microorganisms. This study assessed the effectiveness of ALH gel on healing time, bacterial growth, patient satisfaction, and cost of treatment. Single-arm, prospective case series. Seven patients (aged 7-64 years) with partial-thickness facial burns were recruited from a northeastern US burn center. All patients cleansed their wounds daily with soap and water, after which they applied ALH gel. Three physicians independently rated healing using wound photography and daily tests for the presence of exudate. Wound cultures on days 1 and 7 (±2 days) assessed bacterial growth. Patients completed a satisfaction survey at the end of treatment, and cost of treatment was calculated. Healing time ranged from 3 to 14 days (mean, 8.1 days). Wound cultures revealed normal bacterial growth on days 1 and 7 for all patients. Patients rated ALH gel favorably, with the most common complaint of stickiness in 5 patients. One patient experienced transient burning on application that did not interrupt treatment. Average hospital-based cost of treatment was $26.15 per patient. Healing time was congruent with or better than what would have been expected with standard treatment. Furthermore, despite no antibiotic treatment, wound culture results yielded no abnormal bacterial growth. Finally, patients overall reported satisfaction with treatment. The findings of this study suggest that ALH is a clinically and economically valuable treatment for partial-thickness facial burns.

Hands-free image capture, data tagging and transfer using Google Glass: a pilot study for improved wound care management.

Chronic wounds, including pressure ulcers, compromise the health of 6.5 million Americans and pose an annual estimated burden of $25 billion to the U.S. health care system. When treating chronic wounds, clinicians must use meticulous documentation to determine wound severity and to monitor healing progress over time. Yet, current wound documentation practices using digital photography are often cumbersome and labor intensive. The process of transferring photos into Electronic Medical Records (EMRs) requires many steps and can take several days. Newer smartphone and tablet-based solutions, such as Epic Haiku, have reduced EMR upload time. However, issues still exist involving patient positioning, image-capture technique, and patient identification. In this paper, we present the development and assessment of the SnapCap System for chronic wound photography. Through leveraging the sensor capabilities of Google Glass, SnapCap enables hands-free digital image capture, and the tagging and transfer of images to a patient’s EMR. In a pilot study with wound care nurses at Stanford Hospital (n=16), we (i) examined feature preferences for hands-free digital image capture and documentation, and (ii) compared SnapCap to the state of the art in digital wound care photography, the Epic Haiku application. We used the Wilcoxon Signed-ranks test to evaluate differences in mean ranks between preference options. Preferred hands-free navigation features include barcode scanning for patient identification, Z(15) = -3.873, p < 0.001, r = 0.71, and double-blinking to take photographs, Z(13) = -3.606, p < 0.001, r = 0.71. In the comparison between SnapCap and Epic Haiku, the SnapCap System was preferred for sterile image-capture technique, Z(16) = -3.873, p < 0.001, r = 0.68. Responses were divided with respect to image quality and overall ease of use. The study’s results have contributed to the future implementation of new features aimed at enhancing mobile hands-free digital photography for chronic wound care.

Scoping study into wound management nurse practitioner models of practice.

The primary objective of this research was to investigate wound management nurse practitioner (WMNP) models of service for the purposes of identifying parameters of practice and how patient outcomes are measured. A scoping study was conducted with all authorised WMNPs in Australia from October to December 2012 using survey methodology. A questionnaire was developed to obtain data on the role and practice parameters of authorised WMNPs in Australia. The tool comprised seven sections and included a total of 59 questions. The questionnaire was distributed to all members of the WMNP Online Peer Review Group, to which it was anticipated the majority of WMNPs belonged. Twenty-one WMNPs responded (response rate 87%), with the results based on a subset of respondents who stated that, at the time of the questionnaire, they were employed as a WMNP, therefore yielding a response rate of 71% (n=15). Most respondents (93%; n=14) were employed in the public sector, with an average of 64 occasions of service per month. The typical length of a new case consultation was 60 min, with 32 min for follow ups. The most frequently performed activity was wound photography (83%; n=12), patient, family or carer education (75%; n=12), Doppler ankle-brachial pressure index assessment (58%; n=12), conservative sharp wound debridement (58%; n=12) and counselling (50%; n=12). The most routinely prescribed medications were local anaesthetics (25%; n=12) and oral antibiotics (25%; n=12). Data were routinely collected by 91% of respondents on service-related and wound-related parameters to monitor patient outcomes, to justify and improve health services provided. This study yielded important baseline information on this professional group, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are measured.

Development and evaluation of a novel smart device-based application for burn assessment and management

We have developed a novel software application that provides a simple and interactive Lund–Browder diagram for automatic calculation of total body surface area (TBSA) burned, fluid formula recommendations, and serial wound photography on a smart device platform. The software was developed for the iPad (Apple, Cupertino, CA) smart device platforms. Ten burns ranging from 5 to 95% TBSA were computer generated on a patient care simulator using Adobe Photoshop CS6 (Adobe, San Jose, CA). Burn clinicians calculated the TBSA first using a paper-based Lund–Browder diagram. Following a one-week “washout period”, the same clinicians calculated TBSA using the smart device application. Simulated burns were presented in a random fashion and clinicians were timed. Percent TBSA burned calculated by Peregrine vs. the paper-based Lund–Browder were similar (29.53 [25.57] vs. 28.99 [25.01], p=0.22, n=7). On average, Peregrine allowed users to calculate burn size significantly faster than the paper form (58.18 [31.46] vs. 90.22 [60.60]s, p<0.001, n=7). The smart device application also provided 5 megapixel photography capabilities, and acute burn resuscitation fluid calculator. We developed an innovative smart device application that enables accurate and rapid burn size assessment to be cost-effective and widely accessible.