scholarly journals Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

10.2196/15574 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e15574
Author(s):  
Lihong Chen ◽  
Lihui Cheng ◽  
Wei Gao ◽  
Dawei Chen ◽  
Chun Wang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cohort Studies ◽  
Mobile Phones ◽  
Standard Care ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Meta Analysis ◽  
Wound Management ◽  
Efficacy And Safety ◽  
Chronic Wound Management

Background Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. Objective The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. Methods We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. Results A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. Conclusions Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

scholarly journals Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis (Preprint)

2019 ◽  
Author(s):  
Lihong Chen ◽  
Lihui Cheng ◽  
Wei Gao ◽  
Dawei Chen ◽  
Chun Wang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cohort Studies ◽  
Mobile Phones ◽  
Standard Care ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Meta Analysis ◽  
Wound Management ◽  
Efficacy And Safety ◽  
Chronic Wound Management

BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; <i>P</i>=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; <i>P</i>=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; <i>P</i>=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; <i>P</i>&lt;.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; <i>P</i>=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; <i>P</i>=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

Chronic wounds: the challenges of appropriate management

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S26-S32 ◽  
Author(s):  
Leanne Atkin
Keyword(s):  
Wound Healing ◽  
Health Services ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Management ◽  
Product Selection ◽  
Wound Assessment ◽  
Moisture Balance ◽  
Selection For ◽  
Chronic Wound Management

The immense burden imposed by chronic wounds—those persisting over 6 weeks despite active intervention—on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

PD42 Safety And Cost-Effectiveness Of Platelet-Rich Plasma For Chronic Wounds

2018 ◽  
Vol 34 (S1) ◽  
pp. 143-144
Author(s):  
Tasmania del Pino-Sedeño ◽  
Renata Linertová ◽  
Maria M. Trujillo-Martin ◽  
Ana Toledo-Chávarri ◽  
Sybille Káiser Girardot ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cost Effectiveness ◽  
Standard Care ◽  
Chronic Wounds ◽  
Standard Treatment ◽  
Chronic Wound ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis

Introduction:New therapeutic strategies have been established in chronic wound healing procedures, such as the use of platelet-rich plasma (PRP). There is currently still uncertainty about the effectiveness, cost-effectiveness and real safety of PRP in promoting chronic wound healing and what specific types of chronic wounds can benefit most from its use.Methods:We conducted a systematic review of available scientific literature on the effectiveness, safety and cost-effectiveness of PRP compared to placebo, standard care or alternative topical therapies for the treatment of chronic wounds in adults. Overall effect size was estimated through a meta-analysis. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a 5-year horizon, from the perspective of the Spanish National Health Service (NHS) for the PRP versus standard treatment in patients with diabetic foot ulcers. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.Results:Sixteen RCTs and four observational studies were included for the effectiveness and safety meta-analysis. The primary outcome was the proportion of chronic wounds completely healed: 143 patients out of 334 (42.8 percent) were cured in the standard treatment arm and 251 patients out of 375 (66.9 percent) in the PRP arm, relative risk (RR) 1.68 (95% CI: 1.22–2.31). It was unclear whether there was a difference in the risk of infection (RR 0.53, 95% CI: 0.10–2.71) or adverse events (RR 1.05, 95% CI: 0.29–3.88) between PRP and standard care. Three studies were considered for the cost-effectiveness analysis. In the base case analysis, PRP led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio (ICER) of EUR 41,767 (USD 48,323)/QALY.Conclusions:PRP treatment is more expensive and more effective than standard treatment. The estimated ICER is above the acceptability threshold in Spain.

Fluorescent Imaging and Precise Suppression of Bacterial Infection in Chronic Wounds by Porphyrin-Based Metal-Organic Framework Nanorod

2021 ◽  
Author(s):  
zhen zou ◽  
Lihua Zhang ◽  
Minzhi Ouyang ◽  
Yufei Zhang ◽  
Huanxiang Wang ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Antibacterial Agents ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Metal Organic Framework ◽  
Critical Role ◽  
Fluorescent Imaging ◽  
Wound Management ◽  
Metal Organic ◽  
Chronic Wound Management

Nano-antibacterial agents play a critical role in chronic wound management. However, an intelligent nanosystem that can provide both visual warning of infection and precise sterilization remains a hurdle. Herein, a...

scholarly journals Ekek anti mikroba terapi larva

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Sunny Wangko
Keyword(s):  
Wound Healing ◽  
Chronic Wound ◽  
Healing Process ◽  
Wound Management ◽  
Wound Healing Process ◽  
Healing Wounds ◽  
Chronic Wound Management ◽  
Very High ◽  
Anti Inflammation ◽  
Larval Therapy

Abstract: Chronic wound is still a world-wide problem that spends a very high cost related to its management and treatment. Although there are a lot of promising studies about wound healing process, the prevalence and incidence of chronic wound and its complications are still high. Conventionally, the management of chronic wound consists of surgical debridement, manual irrigation, dressing, and antimicrobial therapy (topical and/or systemic). It is accepted that microbial biofilm and its complexity play important roles in non-healing wounds. This biofilm consists of polymicrobial colonies embedded in exopolymeric matrix produced by the biofilm itself and has a high tolerance to host defence mechanisme, antibiotics, and antiseptics. Larval therapy has been approved by FDA to be used in chronic wound management. It has antimicrobial effects besides its other effects on wound healing inter alia mechanical debridement, anti-inflammation, angiogenesis, and destabilization of biofilm enzymes. Further studies are needed to explore the effects of larval therapy, especially its excretion/secretion components, so that it can be applicated more aesthetically.Keywords: chronic wound, wound healing process, biofilm, larval therapyAbstrak: Luka kronis merupakan masalah kesehatan di seluruh dunia yang telah memboroskan biaya cukup tinggi. Walaupun telah terjadi kemajuan dan pemahaman mengenai penyembuhan luka, prevalensi dan insidensi luka kronis dan komplikasinya tetap meningkat pesat. Secara konvensional, perawatan luka kronis terdiri dari debrideman, irigasi manual, dressing untuk mempertahankan kelembaban, dan terapi antimikroba (topikal dan atau sistemik). Adanya biofilm mikroba serta kompleksitasnya pada luka kronis telah disepakati sebagai salah satu kunci gagalnya penyembuhan luka. Biofilm mikroba terdiri dari koloni-koloni mikroorganisme polimikrobial terkemas dalam matriks eksopolimerik yang diproduksi olehnya sendiri dan memiliki toleransi tinggi terhadap pertahanan pejamu (host), antibiotik, dan antiseptik. Terapi larva telah diterima oleh FDA dan telah terbukti berefek antimikroba disamping efek lainnya terhadap penyembuhan luka, antara lain: debrideman mekanis, anti-inflamasi, angiogenesis, dan destabilisasi enzim biofilm pada luka. Studi lanjut diperlukan untuk mengeksplorasi efek terapi larva terutama komponen ekskresi/skresi larva terhadap penyembuhan luka agar dapat diaplikasikan secara lebih estetik.Kata kunci: luka kronis, penyembuhan luka, biofilm, terapi larva

Dressing Selection in Chronic Wound Management

2002 ◽  
Vol 92 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Susie Seaman
Keyword(s):  
Wound Healing ◽  
Chronic Wound ◽  
Wound Care ◽  
Wound Management ◽  
Transparent Films ◽  
Chronic Wound Management

The concept of moist wound healing has been examined and gradually accepted by wound care clinicians during the last 40 years, and has led to the development of hundreds of dressings that support a moist wound environment. This article discusses the characteristics of an ideal dressing in an effort to assist clinicians in making appropriate dressing choices from common categories, including transparent films, hydrocolloids, foams, absorptive wound fillers, hydrogels, collagens, and gauzes. Reimbursement issues are also discussed. (J Am Podiatr Med Assoc 92(1): 24-33, 2002)

scholarly journals Povidone Iodine Ointment vs Cadexomer Iodine Ointment in Management of the Chronic Wound: A Study Protocol

2021 ◽  
pp. 33-37
Author(s):  
Shubham Gupta ◽  
Raju Kamalrao Shinde ◽  
Sangita Shinde
Keyword(s):  
Health Care ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Povidone Iodine ◽  
Wound Management ◽  
Tissue Formation ◽  
Granulation Tissue Formation

Introduction: Chronic wound and its care has always been a health burden for patient, health care professionals and the entire health care system. There have been certain topical preparations available in market today for application in chronic wound management. In our study, we are comparing effects of cadexomer and povidone iodine ointment in context of reduction in bacterial overload, slough reduction, facilitations of granulation tissue formation, reduction in size of the wound and ultimately in percentage of wound healing and its cost of management. Aim: Comparison of outcome of Povidone Iodine Ointment and Cadexomer iodine Ointment in management of the wound. Methodology: This cross section observational study has been conducted among 40 patients diagnosed as chronic wound with 20 patients in each group. Student’s paired t-test and Pearson’s Correlation Coefficient is being used as statistical analysis. Results: The percentage of patient treated with cadexomer iodine ointment shows significantly (p<0.05) higher rate of wound healing along with significant reduction in bacterial overload and promotion of granulation tissue formation. Conclusion: Cadexomer as a vector with iodine ointment shows higher rate of reduction of biofilm, slough and debris with better rate of promotion of granulation tissue formation, thus leading to increased and effective rate of healing of wound as well as cost effective management of chronic wounds.

scholarly journals The use of wound dressings as a means to alter the composition of biofilms in a chronic wound model

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Gabriela Nedelea ◽  
Sarah Maddocks
Keyword(s):  
Chronic Wounds ◽  
Chronic Wound ◽  
Low Ph ◽  
Wound Dressings ◽  
Wound Management ◽  
Chronic Infections ◽  
Gram Negative ◽  
Negative Shift ◽  
Wound Model ◽  
Chronic Wound Management

It is estimated that £5 billion are invested yearly into chronic wound management by the NHS. Whilst the demand for treatment rises every year, it has become harder to treat wounds given the burden of antimicrobial resistance. Chronic wounds can easily become harbouring grounds for polymicrobial biofilms in which species interact in specific ways. This study assessed the interactions between two commonly co-isolated chronic wound pathogens: Pseudomonas aeruginosa (ATCC 9027) and Staphylococcus aureus (EMRSA 15), whose biofilm relation initiates a Gram-negative shift. During this phenomenon, P. aeruginosa takes over the majority of the bacterial community, at the detriment of S. aureus. The Gram-negative shift marks the turning point from an acute to a chronic wound. The pH of a chronic wound is typically alkaline, and it was hypothesised that topical dressings with an acidic pH could disrupt the onset of the Gram negative shift, and therefore chronicity. Six different topical dressings with low pH were used in achronic wound model to assess their ability to reverse or delay the Gram-negative shift. It was found that they did not have an impact on the onset of the Gram-negative shift, despite their low pH values. However, the lower the pH of the dressings, the more frequently small colony variant (SCV) bacteria were observed in the biofilm. SCVs are known for causing persistent or chronic infections. It was therefore concluded that low pH dressings alone may not be favourable for managing chronic wound infection.

scholarly journals Update of Hyperbaric Oxygen Therapy in the Management of Chronic Wound

2020 ◽  
Vol 3 (02) ◽  
pp. 422-425
Author(s):  
Ibrahim A Albrethen ◽  
Turki M Alshehri ◽  
Khalid A Albraithen ◽  
Abdullah I Alenezi ◽  
Hussein M Alkahtani ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Management Strategy ◽  
Oxygen Therapy ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Management ◽  
Traditional Therapies ◽  
Chronic Wound Management ◽  
Complex Cases

Hyperbaric oxygen therapy (HBOT) is a type of therapy for wound management that employs pressurized oxygen, which patients breathe for a set period. The aim is to increase the amount of oxygen in a person's body, which should aid the process of wound healing, which is especially crucial for chronic wounds. Multiple evidence from clinical trials and studies suggest that HBOT is more effective when compared to traditional therapies in treating chronic wounds, and especially when managing wounds that develop as a result of diabetes. Additionally, two studies conducted on rats with diabetes and patients with foot ulcers suggest that HBOT can address these complex cases, which can aid in reducing the amputation risk. This paper reviews evidence, which proves that HBOT is an effective chronic wound management strategy.    

Tools and Components of Wound Healing Assessment

2013 ◽  
Author(s):  
Jessica Chin ◽  
Ibrahim Zeid ◽  
Sagar Kamarthi
Keyword(s):  
Wound Healing ◽  
Healing Rate ◽  
Chronic Wound ◽  
Historical Data ◽  
Wound Management ◽  
Wound Assessment ◽  
Healing Wounds ◽  
Chronic Wound Management ◽  
Healing Assessment ◽  
Wound Healing Rate

Chronic wound assessment and analysis has long been a major healthcare issue. Chronic wound management and treatment cost billions of dollars each year. The research to alleviate the burden of non-healing wounds and predicting when they will heal is progressing at incremental pace. Characteristics of a chronic wound are unique to both the patient and wound itself. Like a fingerprint, each wound has a unique set of properties that tell a story about its health and viability. Although each person’s wound is individual, there are a few underlying pathologies that are common amongst all wounds. For example, all wounds have a definite surface area, depth, and temperature at any given time. By knowing these common characteristics across all wounds, we can use both historical data and collected data to determine wound healing patterns and wound healing rates. The purpose of this study is to develop an algorithm that uses photography and statistical modeling to predict an approximate wound healing rate for lower appendage wounds. We focus on lower appendage wounds with a depth of 1–2 mm because lower appendage wounds account for approximately 70% of wounds seen at wound clinics.

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