scholarly journals CO2 laser resurfacing for burn and traumatic scars of the hand and upper extremity

2022 ◽  
Vol 8 ◽  
pp. 205951312110476
Author(s):  
Cameron Cox ◽  
Patrick Bettiol ◽  
Audrey Le ◽  
Brendan J MacKay ◽  
John Griswold ◽  
...  
Keyword(s):  
Health Care ◽  
Laser Therapy ◽  
Upper Extremity ◽  
Upper Extremities ◽  
Assessment Scale ◽  
Hypertrophic Scars ◽  
Care Providers ◽  
Scar Assessment ◽  
Patient Reported ◽  
Scar Quality

Background Scar formation is a normal part of the proliferative phase in wound healing where collagen is remodelled to better approximate normal skin. When collagen is not effectively redistributed, excessive scarring may occur. Recently, CO2 laser has emerged as an adjunct in improving scar quality via remodelling and redistribution of dermal collagen fibres. Due to the paucity of literature related to its use in the hands and upper extremities, we created a study to examine its effects on hypertrophic scars focused on the hands and upper extremities. Methods Patients treated with CO2 laser for hypertrophic scars of the hand and upper extremity were included. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to assess the progression of scar quality. Unpaired t-tests were performed to determine statistical difference between pre- and post-treatment scores on each scale. Pearson correlation coefficients were used to understand the relationship between number of treatments and scar quality. Results Of the 90 patients enrolled, 54 patients completed serial scar assessment forms. All patient and observer-reported POSAS domains showed improvement ( P < 0.05) apart from Itching. All VSS domains showed improvement ( P < 0.05). There was moderate correlation between overall patient-reported opinion of scar quality and Discoloration, Stiffness and Thickness, and strong correlation between overall patient opinion and Irregularity (r = 0.715). All observer-reported domains were strongly correlated (r = 7.56–8.74) with overall observer opinion of scar quality. Conclusion The results of this study may further substantiate CO2 laser as a treatment modality for excessive scarring in a variety of surgical subspecialties. Lay Summary Complex trauma and burns that impact the skin sometimes result in abnormal healing of the skin called, “hypertrophic scarring”. In our study we assessed how using focused CO2 laser therapy impacts patients and health care provider assessment of wound progression. Our results were based upon patient reported and healthcare provider observations based upon two standardized forms the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). What we found is that after CO2 Laser Therapy, our 64 patients with 77 treated scars received on average almost 3 treatments and these treatments helped them with physical function and improved aesthetic appearance of their scars. The health care providers also found that the treatments improved functional and aesthetic end points. Overall, our study helps substantiate the body of evidence that using CO2 laser therapy improves aesthetics and function of hypertrophic scars in the upper extremity.

A prospective, randomized clinical trial of transverse versus longitudinal incisions for trigger finger release

2019 ◽  
Vol 44 (8) ◽  
pp. 810-815 ◽  
Author(s):  
Nikolas H. Kazmers ◽  
David Holt ◽  
Andrew R. Tyser ◽  
Angela Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Assessment Scale ◽  
Trigger Finger ◽  
Functional Improvement ◽  
Level Of Evidence ◽  
Scar Assessment ◽  
Significant Difference ◽  
Patient Reported ◽  
Scale Scores ◽  
Scar Quality ◽  
To Receive

We investigated whether incision type affects scar quality or outcome following trigger finger release. Our primary and secondary hypotheses were that transverse and longitudinal incision types yield similar scar quality and functional improvement. Digits undergoing trigger finger release at the participating hospitals were randomized to receive transverse or longitudinal incisions. The Patient Scar Assessment Scale, Observer Scar Assessment Scale, and the Disabilities of the Arm, Shoulder and Hand score were collected at 8 and 54 weeks postoperatively. Of 86 randomized patients, 67 patients (71%) had followed-up at 54 weeks postoperatively. We found no significant differences in above three assessments between the incisions at either time-point. Among patients receiving both incision types for multiple simultaneous trigger finger release, there were no significant differences in Patient Scar Assessment Scale or Observer Scar Assessment Scale scores. We found no significant difference in the scar quality and improvement in patient-reported disability with transverse or longitudinal incisions for trigger finger release. Level of evidence: II

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

scholarly journals Japan Scar Workshop (JSW) Scar Scale (JSS) for Assessing Keloids and Hypertrophic Scars

2020 ◽  
pp. 133-140
Author(s):  
Rei Ogawa
Keyword(s):  
Hypertrophic Scar ◽  
Assessment Tool ◽  
Treatment Method ◽  
Response To Therapy ◽  
Assessment Scale ◽  
Response To Treatment ◽  
Hypertrophic Scars ◽  
Scar Assessment ◽  
Appropriate Treatment

AbstractThe Vancouver scar scale, the Manchester scar scale, and the Patient and Observer Scar Assessment Scale (POSAS) are all very well-known scar evaluation methods. These tools are based on a number of scar variables, including color, height, and pliability. However, since all were mainly developed to evaluate burn scars, they are difficult to use in clinical practice for keloids and hypertrophic scars. This is because these pathological scars require both differential diagnosis and a way to evaluate their response to therapy. The Japan Scar Workshop (JSW) has sought to develop a scar assessment scale that meets these clinical needs. The first version of this scar assessment tool was named the JSW scar scale (JSS), and it was reported in 2011. In 2015, the revised second version was reported. The JSS consists of two tables. One is a scar classification table that is used to determine whether the scar is a normal mature scar, a hypertrophic scar, or a keloid. This grading system helps the user to select the most appropriate treatment method for the scar. The other table in the JSS is an evaluation table that is used to judge the response to treatment and for follow-up. Both tables contain sample images of each subjective keloid/hypertrophic scar item that allow the user to evaluate each item without hesitation.

Pain Associated With Continuous Intravenous Infusion of Bumetanide: A Case Series

2021 ◽  
Vol 41 (2) ◽  
pp. 44-50
Author(s):  
Lori B. Herges ◽  
Jacob C. Jentzer ◽  
Diane D. Brighton ◽  
Joseph R. Herges ◽  
Narith N. Ou
Keyword(s):  
Health Care ◽  
Adverse Event ◽  
Continuous Infusion ◽  
Health Care Providers ◽  
Early Recognition ◽  
Case Series ◽  
Clinical Findings ◽  
Care Providers ◽  
Comfort Care ◽  
Patient Reported

Introduction Bumetanide can induce generalized musculoskeletal pain when administered as a continuous infusion, an effect that may be underrecognized. The purpose of this case series is to educate health care providers about the incidence and presentation of pain associated with bumetanide infusions, adding to the existing literature describing this adverse event. Clinical Findings Of 40 critically ill patients, 15 (38%) had increased pain scores after initiation of a continuous infusion of bumetanide, with symptoms commonly occurring 12 to 24 hours after initiation of the infusion. Reported descriptions of the pain included generalized aching, soreness, burning, allodynia, headaches, and exacerbation of underlying pain in localized areas. Increases in patient-reported pain correlated directly with initiation of the continuous infusion of bumetanide. Diagnosis Four of the 15 bumetanide-associated pain events (27%) were recognized as such by the health care team. Interventions Bumetanide was promptly discontinued in the 4 identified cases. The 11 patients (73%) whose pain was not recognized as related to bumetanide remained on a continuous infusion of bumetanide and received pain medications including opioids. Infusions were stopped when patients transitioned to dialysis (n = 8 [53%]), began receiving comfort care (n = 5 [33%]), or completed diuresis therapy (n = 2 [13%]). Outcomes For all patients, pain symptoms resolved within 24 to 48 hours after discontinuation of bumetanide infusion with no significant electrolyte abnormalities. Conclusion Bumetanide-induced pain is more common than previously described. Early recognition of this adverse event can prevent patient discomfort and escalation of treatment.

scholarly journals Significant improvement in cancer management in Europe

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Jelenc ◽  
T Albreht
Keyword(s):  
Health Care ◽  
Quality Indicators ◽  
Cancer Control ◽  
Care Providers ◽  
Member States ◽  
Eu Member States ◽  
Cancer Management ◽  
Patient Pathways ◽  
Patient Reported ◽  
Eu Candidate Countries

Abstract Background Cancer management represents one of the most complex disease management segments in health care. Quality National Cancer Control Programmes (NCCPs) play the key role in cancer management in responding to population needs by preventing, detecting and treating cancer only through adequate planning. An effective NCCP represents benefits for patients, citizens, health care providers, health systems and governments. Europe is still characterised by inequalities in cancer control both between and within countries. In response to this challenge, a generic list of evidence-based tools for efficient stewardship and measure of effects of the cancer control will be prepared. Methods A survey on the current state of NCCPs in EU Member States, EEA countries and EU candidate countries and on the presence of some key elements, which NCCPs should include, was conducted in 2018 in the frame of the Joint Action (JA) Innovative Partnership for Action Against Cancer (iPAAC). The completed surveys were analysed; the answers were compared with the report prepared on the basis of the survey carried out in 2011 in the frame of JA EPAAC. Results In total, 33 out of 34 EU Member States, some EEA countries and EU candidate countries completed the survey, the response rate was 97%. Thirty-one out of 33 countries reported that they have a NCCP or another relevant cancer document. Belgium does not have a NCCP, Croatia and Serbia prepared draft versions. The inclusion of patient pathways, quality indicators as well as PROMS in NCCPs is not satisfactory. Only 10 countries included PROMS in their NCCP. Conclusions On the basis of the preliminary results of the survey we conluded that the situation regarding NCCPs in Europe improved in comparison with the situation in 2011. EU countries have mostly adopted a NCCP, plan or strategy as a single or several documents. We aim at developing practical instructions for the successful governance and steering of cancer care in all EU Member States. Key messages The development of NCCPs represents added value for cancer patients in all EU Member States. The inclusion of patient pathways, quality indicators as well as patient reported outcome measures (PROMS) in NCCPs/cancer documents is not satisfactory.

Predictive validity of short term scar quality on final burn scar outcome using the Patient and Observer Scar Assessment Scale in patients with minor to moderate burn severity

Burns ◽  
2017 ◽  
Vol 43 (4) ◽  
pp. 715-723 ◽  
Author(s):  
H. Goei ◽  
C.H. van der Vlies ◽  
W.E. Tuinebreijer ◽  
P.P.M. van Zuijlen ◽  
E. Middelkoop ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Assessment Scale ◽  
Burn Severity ◽  
Short Term ◽  
Burn Scar ◽  
Scar Assessment ◽  
Scar Quality

scholarly journals “I Like the Idea of It…But Probably Wouldn’t Use It” - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Jennifer Dickman Portz ◽  
Kelsey Lynett Ford ◽  
Kira Elsbernd ◽  
Christopher E Knoepke ◽  
Kelsey Flint ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Qualitative Study ◽  
Real Time ◽  
Health Care Providers ◽  
Patient Reported Outcomes ◽  
Care Providers ◽  
Time Data ◽  
Patient Reported ◽  
Real Time Data

BACKGROUND Many mobile health (mHealth) technologies exist for patients with heart failure (HF). However, HF mhealth lacks evidence of efficacy, caregiver involvement, and clinically useful real-time data. OBJECTIVE We aim to capture health care providers’ perceived value of HF mHealth, particularly for pairing patient–caregiver-generated data with clinical intervention to inform the design of future HF mHealth. METHODS This study is a subanalysis of a larger qualitative study based on interviewing patients with HF, their caregivers, and health care providers. This analysis included interviews with health care providers (N=20), focusing on their perceived usefulness of HF mHealth tools and interventions. RESULTS A total of 5 themes emerged: (1) bio-psychosocial-spiritual monitoring, (2) use of sensors, (3) interoperability, (4) data sharing, and (5) usefulness of patient-reported outcomes in practice. Providers remain interested in mHealth technologies for HF patients and their caregivers. However, providers report being unconvinced of the clinical usefulness of robust real-time patient-reported outcomes. CONCLUSIONS The use of assessments, sensors, and real-time data collection could provide value in patient care. Future research must continually explore how to maximize the utility of mHealth for HF patients, their caregivers, and health care providers.

Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 56-56
Author(s):  
Sean Molloy ◽  
Jose Pereira ◽  
Esther Green ◽  
Deborah Jane Dudgeon ◽  
Doris Howell ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Symptom Assessment ◽  
Assessment System ◽  
Evidence Based ◽  
Care Providers ◽  
Symptom Screening ◽  
Patient Reported ◽  
Evidence Based Guidelines

56 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are: (a) promote the adoption of electronic symptom assessment using a standardized tool and (b) increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are to manage cancer symptoms through a patient reported measurement tool; improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and drive improvement through the adoption of an electronic symptom assessment platform The following aims were established for this work: (1) Aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month) (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores) (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan) and (4) aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success. (a.) Leadership at all levels of the system; (b.) clinical tools at the point of care; (c) engagement of patients in the design of care; (d) communications support to spread information to all stakeholders; and (e) using to data to drive performance improvement and accountability.

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