Wound hygiene survey: awareness, implementation, barriers and outcomes

2021 ◽  
Vol 30 (7) ◽  
pp. 582-590
Author(s):  
Chris Murphy ◽  
Leanne Atkin ◽  
Jenny Hurlow ◽  
Terry Swanson ◽  
Melina Vega de Ceniga
Keyword(s):  
Wound Care ◽  
Free Text ◽  
Implementation Barriers ◽  
Barriers To Adoption ◽  
Aggregated Data ◽  
Care Specialist ◽  
The Us ◽  
Barriers To Implementation ◽  
Successful Approach ◽  
One Year

Objective: In light of the COVID-19 pandemic, which has resulted in changes to caseload management, access to training and education, and other additional pressures, a survey was developed to understand current awareness and implementation of the wound hygiene concept into practice one year on from its dissemination. Barriers to implementation and outcomes were also surveyed. Method: The 26-question survey, a mixture of multiple choice and free-text, was developed by the Journal of Wound Care projects team, in consultation with ConvaTec, and distributed globally via email and online; the survey was open for just over 12 weeks. Due to the exploratory nature of the research, non-probability sampling was used. The authors reviewed the outputs of the survey to draw conclusions from the data, with the support of a medical writer. Results: There were 1478 respondents who agreed to the use of their anonymised aggregated data. Nearly 90% were from the US or UK, and the majority worked in wound care specialist roles, equally distributed between community and acute care settings; 66.6% had been in wound care for more than 8 years. The respondents work across the spectrum of wound types. More than half (57.4%) had heard of the concept of wound hygiene, of whom 75.3% have implemented it; 78.7% answered that they ‘always’ apply wound hygiene and 20.8% ‘sometimes’ do so. The top three barriers to adoption were confidence (39.0%), the desire for more research (25.7%) and competence (24.8%). Overall, following implementation of wound hygiene, 80.3% reported that their patients' healing rates had improved. Conclusion: Respondents strongly agreed that implementing wound hygiene is a successful approach for biofilm management and a critical component for improving wound healing rates in hard-to-heal wounds. However, the barriers to its uptake and implementation demonstrate that comprehensive education and training, institutional support for policy and protocol changes, and more clinical research are needed to support wound hygiene.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

Safety of reduced anti-thrombotic strategies in HeartMate II patients: A one-year analysis of the US-TRACE Study

2015 ◽  
Vol 34 (12) ◽  
pp. 1542-1548 ◽  
Author(s):  
Jason N. Katz ◽  
Robert M. Adamson ◽  
Ranjit John ◽  
Antone Tatooles ◽  
Kartik Sundareswaran ◽  
...  
Keyword(s):  
Heartmate Ii ◽  
The Us ◽  
One Year

scholarly journals 318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S231-S232
Author(s):  
Shiwei Zhou ◽  
Brian M Schmidt ◽  
Oryan Henig ◽  
Keith S Kaye
Keyword(s):  
Diabetic Foot ◽  
Medical Management ◽  
Wound Care ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
Complete Healing ◽  
Knee Amputation ◽  
Management Group ◽  
One Year ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation. Methods An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured. Results Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation. One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017). Conclusion In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended. Disclosures All Authors: No reported disclosures

scholarly journals Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Sharon Licqurish ◽  
Jane Gunn ◽  
Shaun Brennecke ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Delphi Survey ◽  
Care Practice ◽  
Free Text ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

ID: 3527213 THIRD SPACE ENDOSCOPY AFTER FORMAL ENDOSCOPY ADVANCED FELLOWSHIP TRAINING IN THE US: ONE YEAR LINEAR FOLLOW UP OF INDEPENDENT PRACTICE

2021 ◽  
Vol 93 (6) ◽  
pp. AB281
Author(s):  
Mohamed Abdelfatah Magdy ◽  
Ali M. Ahmed ◽  
Shajan Peter ◽  
Douglas R. Morgan ◽  
Qiang Cai
Keyword(s):  
Third Space ◽  
Fellowship Training ◽  
Independent Practice ◽  
The Us ◽  
One Year

ISM-MICMAC approach for analysis of project-based learning barriers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Syed Khalid Perwez ◽  
Goutam Kumar Kundu
Keyword(s):  
Structural Model ◽  
Educational Institution ◽  
Project Based Learning ◽  
Educational Institutions ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
Higher Educational Institutions ◽  
Content Type ◽  
Barriers To Implementation ◽  
Higher Educational

Purpose This paper aims to identify and model the key barriers to implementation of project-based learning (PjBL) in higher educational institution. Design/methodology/approach Using the interpretive structural modelling (ISM) technique, the study has developed a hierarchical-based model, depicting the mutual relationships amongst the key barriers to implementation of PjBL. Additionally, the paper has performed Matrice d’ Impacts Croises Multiplication Appliqué an Classement (MICMAC) analysis to categorize the barriers in terms of their driving and dependence power. Findings The study has identified the key barriers to implementation of PjBL and presented an integrated model using ISM. Higher educational institutions need to pay attention to diagnose and overcome these hindrances for effective implementation of PjBL in their programmes. Research limitations/implications The study adopts a systematic way to model the relevant barriers to implementation of PjBL. The ISM-based model would help higher education institutions to prioritize the issues as the barriers are hierarchically structured. As the input to model development is based on the experts’ opinions, it may be biased, influencing the final output of the structural model. Originality/value The presentation of PjBL implementation barriers in the form of an ISM-based model is a new effort. The model would be useful to understand the barriers and overcome these for the successful implementation of PjBL in higher educational institutions.

scholarly journals Achieving Elusive Teacher Change through Challenging Myths about Learning: A Blended Approach

2018 ◽  
Vol 8 (3) ◽  
pp. 98 ◽  
Author(s):  
Robin Anderson ◽  
Jo Boaler ◽  
Jack Dieckmann
Keyword(s):  
Student Learning ◽  
Professional Learning ◽  
English Learners ◽  
Instructional Practice ◽  
Student Beliefs ◽  
The Us ◽  
Math Test ◽  
Math Test Scores ◽  
One Year ◽  
Mathematics Teaching Methods

The idea that success in mathematics is only available to those born as “mathematics people” has been challenged in recent years by neuroscience, showing that mathematics pathways develop in the brain through learning and practice. This paper reports on a blended professional learning model of online and in-person meetings during which 40 teachers in 8 school districts in the US learned about the new brain science, challenging the “math person” myth, as well as effective mathematics teaching methods. We refer to the combination as a Mathematical Mindset Approach. Using mixed methods, we conducted a one-year study to investigate teacher and student learning in a Mathematical Mindset network. We collected data on teacher and student beliefs, teacher instructional practice, and student learning gains on state achievement tests. The results from our quantitative analyses found statistically significant positive improvements in student beliefs, teacher’s instructional practice, and on students’ math test scores. The mindset approach particularly raised the achievement of girls, English learners, and economically disadvantaged students. Based on our qualitative analysis, we propose that the success of the intervention rests upon two central factors: (1) The different forms of PD served to eradicate the learning myths that had held up teachers and learners; and that (2) Teachers had space for identity work as mathematical learners.

Assessing the Difficulty and Time Cost of De-identification in Clinical Narratives

2006 ◽  
Vol 45 (03) ◽  
pp. 246-252 ◽  
Author(s):  
W. F. Phillips ◽  
S. Phansalkar ◽  
S. A. Sims ◽  
J. F. Hurdle ◽  
D. A. Dorr
Keyword(s):  
Regular Expression ◽  
Free Text ◽  
Time Cost ◽  
Clinical Notes ◽  
The Us ◽  
Important Challenge ◽  
Automated Technique ◽  
Manual Review ◽  
Simple Search ◽  
Selection Of

Summary Objective: To characterize the difficulty confronting investigators in removing protected health information (PHI) from cross-discipline, free-text clinical notes, an important challenge to clinical informatics research as recalibrated by the introduction of the US Health Insurance Portability and Accountability Act (HIPAA) and similar regulations. Methods: Randomized selection of clinical narratives from complete admissions written by diverse providers, reviewed using a two-tiered rater system and simple automated regular expression tools. For manual review, two independent reviewers used simple search and replace algorithms and visual scanning to find PHI as defined by HIPAA, followed by an independent second review to detect any missed PHI. Simple automated review was also performed for the “easy” PHI that are number- or date-based. Results: From 262 notes, 2074 PHI, or 7.9 ± 6.1 per note, were found. The average recall (or sensitivity) was 95.9% while precision was 99.6% for single reviewers. Agreement between individual reviewers was strong (ICC = 0.99), although some asymmetry in errors was seen between reviewers (p = 0.001). The automated technique had better recall (98.5%) but worse precision (88.4%) for its subset of identifiers. Manually de-identifying a note took 87.3 ± 61 seconds on average. Conclusions: Manual de-identification of free-text notes is tedious and time-consuming, but even simple PHI is difficult to automatically identify with the exactitude required under HIPAA.

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