A novel debridement device for the treatment of hard-to-heal wounds: a prospective trial

2021 ◽  
Vol 30 (Sup5) ◽  
pp. S32-S36
Author(s):  
Omar Al-Jalodi ◽  
Laura M Serena ◽  
Kristy Breisinger ◽  
Keyur Patel ◽  
Khristina Harrell ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Wound Care ◽  
Bacterial Load ◽  
Prospective Trial ◽  
Comfort Level ◽  
Care Practice ◽  
Prospective Clinical Study ◽  
Bacterial Burden ◽  
Before And After ◽  
Direct Pressure

Objective: Debridement, the removal of nonviable tissue, forms the foundation of wound care practice. Clinicians have a variety of debridement methods at their disposal: sharp, biologic, enzymatic, autolytic and mechanical. The choice of debridement technique depends on the patient care setting, ulcer type and the clinician's experience, training, comfort level and licensure. This prospective study evaluated a novel debridement instrument, EZ-Debride (MDM Ventures, US). Cutting flutes on the head of the tool permit uniform removal of dead tissue while lessening the risk of deeper injury. It may also minimise pain during the debridement procedure. Method: Subjects with hard-to-heal wounds, drawn from a single wound care centre, participated in this institutional review board-approved prospective clinical study. Pain was measured before, during and after debridement using a numerical scale. Assessment of bacterial burden using fluorescence imaging (MolecuLight, Canada) was performed before and after debridement. Results: Enrolment of 10 male and 12 female subjects, with a total of 28 wounds, was carried out over a two-month period by two investigators at a single institution. The average age of subjects was 64 years (range: 22–95 years). The average wound duration was 29 weeks (range: 6–142 weeks). Wound types included diabetic foot, venous leg and pressure ulcers, post-surgical and traumatic wounds. The average pain score at the time of enrolment was 3.9. Subjects reported an average increase in pain with debridement of 0.6 points (range: 0–8). Fluorescence imaging demonstrated a reduction in bacterial load in 69% of cases, with complete resolution in 19% of wounds. Haemostasis was achieved with direct pressure in all cases and the only adverse event was a wound infection that occurred four days after debridement. Conclusion: The results suggest that this novel debridement tool can safely remove nonviable tissue with minimal discomfort and reduce bacterial burden similar to results achieved by sharp debridement.

INFORMATION NEEDS OF DIGESTIVE TRACT SURGERY PATIENTS BEFORE AND AFTER THE SURGERY: AN EXPLORATORY STUDY OF WESTERN LITHUANIA

2019 ◽  
Vol 4 ◽  
pp. 154
Author(s):  
Lina Gedrime ◽  
Natalja Istomina-Fatkulina ◽  
Indre Brasaite ◽  
Sanna Salanterä
Keyword(s):  
Digestive Tract ◽  
Nursing Care ◽  
Information Needs ◽  
Wound Care ◽  
Gastrointestinal Surgery ◽  
Care Practice ◽  
Post Surgery ◽  
Lack Of Information ◽  
Before And After ◽  
Fear And Anxiety

The aim of this study was to describe the information needs of patients undergoing gastrointestinal surgery in Western Lithuania. Methods. This data were collected from patients of three Klaipeda city hospitals performing digestive tract surgeries in January – March 2015. The interview responses (n = 86) were analyzed inductively with thematic content analysis. Results. The interview revealed lack of information about disease, treatment and nursing care. The participants expressed fear and worries about their forthcoming surgery, anesthesia, pain, the ways of pain management, possible complications and their prevention as well as the future concerning their disease in general. Conclusions. The results show that the participants had not got enough information about treatment, nursing, anesthesia, rehabilitation, wound care or about post-surgery period. Instead they felt fear and anxiety. The participants were not included into treatment and nursing processes. According to the participants’ responses, the information needs were different before and after the surgery. Lack of information prevents patients from acting self-dependently in their care. Practice implications. Patient oriented approach to patient education and innovative ways of information delivery are needed in Lithuanian nursing care of patient’s having a gastrointestinal surgery. 

Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S44-S52 ◽  
Author(s):  
Windy Cole ◽  
Stacey Coe
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Imaging System ◽  
Wound Care ◽  
Point Of Care ◽  
Bacterial Load ◽  
Case Series ◽  
Wound Area ◽  
Wound Debridement ◽  
Wound Bed Preparation

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

The safety of punch biopsies on hard-to-heal wounds: a large multicentre clinical trial

2020 ◽  
Vol 29 (Sup2c) ◽  
pp. S4-S7
Author(s):  
Thomas E. Serena ◽  
Windy Cole ◽  
Stacey Coe ◽  
Khristina Harrell ◽  
Laura Serena ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adverse Events ◽  
Fluorescence Imaging ◽  
Clinical Examination ◽  
Bacterial Load ◽  
Punch Biopsy ◽  
Wound Management ◽  
Care Practice ◽  
Safe Procedure ◽  
Multicentre Clinical Trial

Objective: Punch biopsy is a simple and effective diagnostic technique used in hard-to-heal wound management. Histologic examination can rule out cancer in the wound bed or diagnose vasculitis in a hard-to-heal or suspicious ulcer. A biopsy can determine the level of bacteria in an ulcer when infection is suspected. Despite its use, health professionals practicing in wound clinics hesitate to perform punch biopsies. The reasons vary from the invasive nature of the procedure to a fear of complications. Methods: A multicentre clinical trial evaluated the addition of fluorescence imaging to clinical examination in determining bacterial burden in hard-to-heal wounds. The protocol required a 6mm punch biopsy of any area (up to three) suspected of having moderate-to-high bacteria levels either on clinical examination or fluorescence image. If clinical examination and fluorescence imaging both did not indicate bacteria, the health professional took a biopsy of the centre of the ulcer. The biopsies were performed under local anaesthesia after cleansing the ulcer bed with sterile normal saline. Haemostasis was achieved with direct pressure and the occasional topical clotting agent. All of the patients were followed for 30 days to monitor for adverse events. Results: A total of 350 patientis with wounds (diabetic foot ulcer n=138; venous leg ulcer n=106; pressure ulcer n=22; surgical site infection n=60; other n=24), enrolled by 20 investigators at 14 sites in the US, underwent a total of 412 punch biopsies. Haemostasis was achieved in all 412 biopsies. No biopsy sites required cautery or suture ligation to control bleeding. No subjects returned to the clinic secondary to bleeding. A patient developed an infection three days post-biopsy that could have been due to the punch biopsy. However, the patient was HIV-positive and the quantitative biopsy was positive for infection, biopsy bacterial load of 106 colony forming units (CFU)/g. Conclusion: This trial used a 6mm punch to obtain tissue for culture, histology and additional biomarker research. In daily wound care practice, a smaller 3mm punch suffices. Adverse events were rare despite the larger biopsy. Punch biopsies are a safe procedure for obtaining tissue for histologic or microbiologic analysis.

Early change of thyroid hormone concentration after 131I treatment in patients with solitary toxic adenoma

2002 ◽  
Vol 41 (04) ◽  
pp. 178-183 ◽  
Author(s):  
V. Fidler ◽  
K. Zaletel ◽  
S. Gaberšček ◽  
S. Hojker ◽  
E. Pirnat
Keyword(s):  
Thyroid Hormone ◽  
Antithyroid Drugs ◽  
Prospective Clinical Study ◽  
Hormone Concentration ◽  
Toxic Adenoma ◽  
Free Triiodothyronine ◽  
Thyroid Cells ◽  
131I Treatment ◽  
Before And After ◽  
Thyroid Hormone Concentration

Summary Aim: In spite of extensive use of 131I for treatment of hyperthyroidism, the results of early outcome are variable. In our prospective clinical study we tested whether 131I induced necrosis causing clinical aggravation of hyperthyroidism and increasing the free thyroid hormone concentration in the serum of patients with solitary toxic adenoma not pretreated with antithyroid drugs. Patients and methods: 30 consecutive patients were treated with 925 MBq 131I. Serum concentration of thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), thyroglobulin (Tg), and interleukin-6 (IL-6) were measured before and after application of 131I. Results: After application of 131I no clinical worsening was observed. FT4 and fT3 concentration did not change significantly within the first five days, whereas both of them significantly decreased after 12 days (p <0.0001). Slight and clinically irrelevant increase in the level of the two thyroid hormones was observed in 9 patients. Furthermore, we observed a prolonged increase in Tg concentration and a transient increase in IL-6 concentration. Conclusion: Neither evidence of any clinical aggravation of hyperthyroidism nor any significant increase in thyroid hormone concentration by 131I induced necrosis of thyroid cells was found. Therefore, the application of 131I may be considered as a safe and effective treatment for patients with hyperthyroidism due to toxic adenoma.

The Analysis of Nurses’ Positive Deviance Behaviours as a Measure in Preventing the Transmission of Healthcare-Associated Infections (HAIs) at M. Djamil Hospital, Padang, West Sumatera

2018 ◽  
Vol 1 (1) ◽  
pp. 3-7
Author(s):  
Esthika Ariany Maisa ◽  
Yulastri Arif ◽  
Wawan Wahyudi
Keyword(s):  
Grounded Theory ◽  
Wound Care ◽  
Positive Deviance ◽  
Care Practice ◽  
Theory Approach ◽  
Nursing Managers ◽  
Theoretical Sampling ◽  
Develop Theory ◽  
Healthcare Associated ◽  
Grounded Theory Approach

Purpose: To explore the nurses’ positive deviance behaviors as an effort to provide solutions in preventing and controlling infections in the hospital. Method: This is a qualitative research using grounded theory approach. Thirteen nurses from Dr.M.Djamil hospital were selected based on theoretical sampling in order to develop theory as it appears. Nurses were interviewed from June to September 2014. Interviews were thematically analyzed using techniques of grounded theory to then generate a theory from themes formed. Findings: The modes of positive deviance behavior identified were practicing hand hygiene beyond the standards (bringing handsanitizer from home), applying nursing art in wound care practice, placing patients with MRSA infections at the corner side, giving a red mark on a MRSA patient’s bed for easy identification by nurses, changing clothes and shoes in hospital, reducing hooks on the wall, and cleaning the ward on scheduled days. Conclusion: The study shows that nurses have a number of positive deviance behaviors to prevent infection transmission in the wards. It is sugested that the hospital management and nursing managers adopt some of the uncommon solution highlighted by the nurses to solve the HAIs problems in the hospital.

scholarly journals The Effect of Q-Switched Nd:YAG 1064 nm/532 nm Laser in the Treatment of Onychomycosis In Vivo

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Kostas Kalokasidis ◽  
Meltem Onder ◽  
Myrto-Georgia Trakatelli ◽  
Bertrand Richert ◽  
Klaus Fritz
Keyword(s):  
Clinical Study ◽  
Treatment Time ◽  
Prospective Clinical Study ◽  
Self Evaluation ◽  
Time Period ◽  
Level Of Satisfaction ◽  
Before And After ◽  
532 Nm

In this prospective clinical study, the Q-Switched Nd:YAG 1064 nm/532 nm laser (Light Age, Inc., Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14 J/cm2were applied at 9 billionths of a second pulse duration and at 5 Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed “self-evaluation questionnaires” rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064 nm/532 nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time.

scholarly journals Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1219
Author(s):  
Alisha R. Oropallo ◽  
Charles Andersen ◽  
Raymond Abdo ◽  
Jenny Hurlow ◽  
Martha Kelso ◽  
...  
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Clinical Signs ◽  
Care Providers ◽  
Bacterial Burden ◽  
Term Care ◽  
Assessment Protocol ◽  
Treatment Plans

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

scholarly journals High Oxygen Packaging of Atlantic Cod Fillets Inhibits Known Spoilage Organisms, but Sensory Quality Is Not Improved Due to the Growth of Carnobacterium/Carnobacteriaceae

Foods ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1754
Author(s):  
Anlaug Ådland Hansen ◽  
Solveig Langsrud ◽  
Ingunn Berget ◽  
Mari Øvrum Gaarder ◽  
Birgitte Moen
Keyword(s):  
Shelf Life ◽  
Sensory Quality ◽  
Atlantic Cod ◽  
Bacterial Load ◽  
Modified Atmosphere Packaging ◽  
Volatile Components ◽  
Spoilage Bacteria ◽  
Before And After ◽  
Thawing Process ◽  
Short Time

Improved quality control and prolonged shelf life are important actions in preventing food waste. To get an overview of the bacterial diversity of fillets from live stored mature Atlantic cod, bacterial isolates were identified before and after storage (air and vacuum) and freezing/thawing. Based on the load of dominating bacteria, the effect of different packaging methods and a short freezing/thawing process on prolonged shelf-life was evaluated (total viable counts, bacteriota, sensory attributes, and volatile components). Hand filleted (strict hygiene) cod fillets had a low initial bacterial load dominated by the spoilage organism Photobacterium, whereas industrially produced fillets had higher bacterial loads and diversity (Pseudomonas, Arthrobacter, Psychrobacter, Shewanella). The identified bacteria after storage in vacuum or air were similar to the initially identified bacteria. Bacteriota analysis showed that a short time freezing/thawing process reduced Photobacterium while modified atmosphere packaging (MAP; 60%CO2/40%O2 or 60%CO2/40%N2) inhibited the growth of important spoilage bacteria (Photobacterium, Shewanella, Pseudomonas) and allowed the growth of Carnobacterium/Carnobacteriaceae and Acinetobacter. Despite being dominated by Photobacterium, fresh fillets stored in MAP 60%CO2/40%N2 demonstrated better sensory quality after 13 days of storage than fillets stored in MAP 60%CO2/40%O2 (dominated by Carnobacterium/Carnobacteriaceae). Carnobacterium spp. or other members of Carnobacteriaceae may therefore be potential spoilage organisms in cod when other spoilage bacteria are reduced or inhibited.

scholarly journals Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328
Author(s):  
Pushpalatha Bangalore Lingegowda ◽  
Say-Tat Ooi ◽  
Jyoti Somani ◽  
Chelsea Law ◽  
Boon Kiak Yeo
Keyword(s):  
Infectious Diseases ◽  
Diabetic Foot ◽  
Wound Care ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Multidisciplinary Teams ◽  
Diabetic Patients ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

scholarly journals Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?

CJEM ◽  
2012 ◽  
Vol 14 (04) ◽  
pp. 221-227 ◽  
Author(s):  
Peter Macdonald ◽  
Nadia Primiani ◽  
Adam Lund
Keyword(s):  
Wound Care ◽  
Intervention Group ◽  
Comfort Level ◽  
Patient Comfort ◽  
Control Group ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Telephone Contact ◽  
Physician Visits

ABSTRACTObjectives:Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level.Methods:This prospective, controlled, single-blinded, pseudorandomized trial enrolled consecutive ED patients who met the eligibility criteria (age &gt; 19 years, simple lacerations, nonabsorbable sutures, immunocompetent). The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. The control group received wound care instructions alone. Outcomes were assessed by telephone contact at least 14 days after suturing using a standardized questionnaire.Results:Overall, 183 patients were enrolled (93 in the intervention group; 90 in the control group). Significantly more patients performed suture self-removal in the intervention group (91.5%; 95% CI 85.4–97.5) compared to the control group (62.8%; 95% CI 52.1–73.6) (p&lt; 0.001). Patients visited their physician less often in the intervention group (9.8%; 95% CI 3.3–16.2) compared to the control group (34.6%; 95% CI 24.1–45.2%) (p&lt; 0.001). Complication rates were similar in both groups.Conclusion:Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.

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