The Expressiveness of SNOMED CT for Wound Care: Mapping a standardised Item Set for Leg Ulcers to SNOMED CT (Preprint)

2021 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte JOHN ◽  
Ursula Hertha Hübner
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure

BACKGROUND Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations, thus placing particularly high demands on interoperable information exchange that can be achieved using international semantic standards such as SNOMED CT. OBJECTIVE This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. METHODS A clinically consented and profession independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the international reference terminology SNOMED CT. Prior to the mapping, the NKDUC was transformed into an information model that served to systematically identify the relevant items. The mapping process itself was carried out in accordance with the formalism of ISO/TR 12300. As a result, the reliability, equivalence, and coverage rate were determined. RESULTS The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding the two best equivalence categories, the coverage rate of SNOMED CT was 67.2% overall and 64.3% specifically for wounds. CONCLUSIONS The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical condition and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by post-coordination or the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care and thereby responds to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

scholarly journals Expressiveness of SNOMED CT for wound Care – Mapping a Standardised item Set for Leg Ulcers to SNOMED CT

2020 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Lisa Nolte ◽  
Anne Paul ◽  
Philipp Matysek ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Medical Condition ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct

Abstract Background: Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. The interdisciplinary and multiorganisational character of wound care demands interoperable information exchange that can be achieved by using international semantic standards such as SNOMED CT. This study, therefore, aimed to investigate the expressiveness of SNOMED CT in this medical domain, and thereby its clinical usefulness and the potential need for its extension.Methods: In this study, a consented wound care item set, the National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped to the international reference terminology SNOMED CT. In order to derive the relevant items of the wound domain, an information model was developed that served as the foundation for the mapping. The mapping itself was guided by the procedural formalism of ISO TR 12300. As a result, the reliability, equivalence and coverage rate were determined.Results: The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding a symmetric match, the coverage rate of SNOMED CT was 67.2% overall, and 64.3% specifically for wounds. Conclusion: The results show acceptable reliability values. The overall coverage rate shows that two-thirds of the items found a symmetric map, which is a substantial portion of the source item set. As the differences in the coverage rates between different wound care sections demonstrate, some areas, such as “general medical condition” and “wound assessment”, in particular, were covered better than other areas (“wound status”, “diagnostics” and “therapy”). These deficiencies can be mitigated either by post-coordination or the inclusion of new terms in SNOMED CT. In general, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

scholarly journals Expressiveness of an International Semantic Standard for Wound Care: Mapping a Standardized Item Set for Leg Ulcers to the Systematized Nomenclature of Medicine–Clinical Terms

10.2196/31980 ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. e31980
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte John ◽  
Ursula Hertha Hübner
Keyword(s):  
Information Exchange ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure ◽  
Wound Assessment ◽  
Systematized Nomenclature Of Medicine

Background Chronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT). Objective This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. Methods A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections. Results The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%). Conclusions The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

ReadyWrap®: case studies in practice

2019 ◽  
Vol 24 (Sup10) ◽  
pp. S24-S31
Author(s):  
Alison Schofield
Keyword(s):  
Case Studies ◽  
Chronic Wounds ◽  
Wound Care ◽  
Compression Therapy ◽  
Self Management ◽  
Leg Ulcers ◽  
Compression Garments ◽  
Venous Leg Ulcers ◽  
Good Concordance

The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.

scholarly journals Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review (Preprint)

2017 ◽  
Author(s):  
Clara Schaarup ◽  
Louise Bilenberg Pape-Haugaard ◽  
Ole Kristian Hejlesen
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Literature Review ◽  
Clinical Decision Support ◽  
Systematic Literature Review ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Wound Care ◽  
Clinical Decision ◽  
Decision Support Models

BACKGROUND Chronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers are a massive burden to health care facilities. Many randomized controlled trials on different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, health care professionals are forced to rely on their own experience when making decisions regarding wound care. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems (CDSS) that help health care providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas of the health care sector, partly because they have increased the quality of care, and partially because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on CDSS within the field of wound care to chronic wounds. OBJECTIVE The aims of this systematic literature review are (1) to identify models used in CDSS that support health care professionals treating chronic wounds, and (2) to classify each clinical decision support model according to selected variables and to create an overview. METHODS A systematic review was conducted using 6 databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The search strategy consisted of three facets, respectively: Facet 1 (Algorithm), Facet 2 (Wound care) and Facet 3 (Clinical decision support system). Studies based on acute wounds or trauma were excluded. Similarly, studies that presented guidelines, protocols and instructions were excluded, since they do not require progression along an active chain of reasoning from the clinicians, just their focus. Finally, studies were excluded if they had not undergone a peer review process. The following aspects were extracted from each article: authors, year, country, the sample size of data and variables describing the type of clinical decision support models. The decision support models were classified in 2 ways: quantitative decision support models, and qualitative decision support models. RESULTS The final number of studies included in the systematic literature review was 10. These clinical decision support models included 4/10 (40%) quantitative decision support models and 6/10 (60%) qualitative decision support models. The earliest article was published in 2007, and the most recent was from 2015. CONCLUSIONS The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the health care professionals, while qualitative models required interaction with the user.

Maggot Debridement Therapy in Disaster Medicine

2015 ◽  
Vol 31 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Frank Stadler ◽  
Ramon Z. Shaban ◽  
Peter Tatham
Keyword(s):  
Health Care ◽  
Wound Infection ◽  
Low Income ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Wound Care ◽  
Disaster Medicine ◽  
Maggot Debridement Therapy ◽  
Therapeutic Benefits ◽  
Number Of Patients

AbstractBackgroundWhen disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as amputations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster.DiscussionThis report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and amputations in case of life-threatening wound infection.RecommendationsThere are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management activities will also be essential.ConclusionsIn the aftermath of disasters, MDT could play an important role facilitating timely and efficient medical treatment and improving patient outcomes. Existing social, medical, and logistic barriers will need to be overcome for MDT to be mainstreamed in Disaster Medicine.StadlerF,ShabanRZ,TathamP.Maggot debridement therapy in Disaster Medicine.Prehosp Disaster Med.2016;31(1):79–84.

Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S6-S11
Author(s):  
Julie Mullings
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Compression Therapy ◽  
Leg Ulcer ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Correct Treatment ◽  
Treatment Choices ◽  
Venous Leg Ulcers ◽  
The Uk

Research has shown that leg ulcers represent the largest category of wound type treated within the UK. Venous leg ulcers are often classified as chronic wounds with increased protease levels causing the wound to become suspended in the inflammatory stage, which leads to delayed healing. If treatment choices are not evidence-based and appropriate regimens are not instigated early on in the wound care journey, the cost to both the patient and the healthcare service is substantial. Recent guidance from the National Institute of Health and Care Excellence (NICE) recommends UrgoStart (Urgo Medical) for treating venous leg ulcers as an adjunct therapy to the gold standard of compression therapy. Correct treatment choices must be made by clinicians using up-to-date relevant wound care knowledge. Evidence-based treatment algorithms and pathways can assist with correct product and therapy placement, assisting decision-making to improve patient outcomes. The present article describes a patient-centred leg ulcer pathway that embeds NICE guidance.

Improving Would Healing Ability by Training: Experiences of China

2018 ◽  
Vol 17 (3) ◽  
pp. 190-194 ◽  
Author(s):  
Yufeng Jiang ◽  
Shuliang Lu ◽  
Bin Wen ◽  
Xiaobing Fu
Keyword(s):  
Wound Healing ◽  
Training Program ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Wound Care ◽  
Medical Doctor ◽  
Great Success ◽  
Training Project ◽  
Would Healing ◽  
Sequential Training

In China, chronic wounds are an important issue. However, wound care knowledge and the skill of health care professionals varies among hospitals and cities. A training program in wound care in China was completed in 2015 and achieved great success. To facilitate expertise in wound healing in China, a sequential training project supported by the Wound Healing Union and the Chinese Medical Doctor Association was initiated. The aim of the training program was mainly to improve experience and skills in wound healing. Until December 2016, a total of 301 medical staffs, including 134 physicians and 167 nurses, have been trained. Most of the doctors (92 of 134) and nurses (142 of 167) were from Grade IIIA/B hospitals, and there were no doctors and nurses from community hospitals. Most participants were satisfied about the training program, and more nurses were satisfied (79%) than doctors (60%). All trainees have completed 4½ months of training and passed a final examination.

Effectiveness of biofilm‐based wound care system on wound healing in chronic wounds

2019 ◽  
Vol 27 (5) ◽  
pp. 540-547 ◽  
Author(s):  
Yukie Mori ◽  
Gojiro Nakagami ◽  
Aya Kitamura ◽  
Takeo Minematsu ◽  
Mikio Kinoshita ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Wound Care ◽  
Care System

Identifying New Pathways and Targets for Wound Healing and Therapeutics from Natural Sources

2021 ◽  
Vol 18 ◽  
Author(s):  
Xinchi Feng ◽  
Jinsong Hao
Keyword(s):  
Wound Healing ◽  
Molecular Mechanisms ◽  
Chronic Wounds ◽  
Wound Care ◽  
Healing Process ◽  
Unmet Need ◽  
Wound Dressings ◽  
Wound Healing Process ◽  
Natural Sources ◽  
Viable Approach

: Chronic wounds remain a significant public problem and the development of wound treatments has been a research focus for the past few decades. Despite advances in the products derived from endogenous substances involved in a wound healing process (e.g. growth factors, stem cells, and extracellular matrix), effective and safe wound therapeutics are still limited. There is an unmet need to develop new therapeutics. Various new pathways and targets have been identified and could become a molecular target in designing novel wound agents. Importantly, many existing drugs that target these newly identified pathways could be repositioned for wound therapy, which will facilitate fast translation of research findings to clinical applications. This review discusses the newly identified pathways/targets and their potential uses in the development of wound therapeutics. Some herbs and amphibian skins have been traditionally used for wound repairs and their active ingredients have been found to act in these new pathways. Hence, screening these natural products for novel wound therapeutics remains a viable approach. The outcomes of wound care using natural wound therapeutics could be improved if we can better understand their cellular and molecular mechanisms and fabricate them in appropriate formulations, such as using novel wound dressings and nano-engineered materials. Therefore, we also provide an update on the advances in the wound therapeutics from natural sources. Overall, this review offers new insights into novel wound therapeutics.

scholarly journals Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Tomasz Banasiewicz ◽  
Rolf Becker ◽  
Adam Bobkiewicz ◽  
Marco Fraccalvieri ◽  
Wojciech Francuzik ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Hospital Admissions ◽  
Wound Care ◽  
Care Center ◽  
Management Strategies ◽  
Hospital Staff ◽  
Wound Management ◽  
Health Care Center ◽  
Single Use

Recent SARS-CoV-2 pandemic leading to a rapidly increasing number of hospitalizations enforced reevaluation of wound management strategies. The optimal treatment strategy for patients with chronic wounds and those recovering from emergency and urgent oncological surgery should aim to minimize the number of hospital admissions, as well as the number of surgical procedures and decrease the length of stay to disburden the hospital staff and to minimize viral infection risk. One of the potential solutions that could help to achieve these goals may be the extensive and early use of NPWT devices in the prevention of wound healing complications. Single-use NPWT devices are helpful in outpatient wound treatment and SSI prevention (ciNPWT) allowing to minimize in-person visits to the health care center while still providing the best possible wound-care. Stationary NPWT should be used in deep SSI and perioperative wound healing disorders as soon as possible. Patient’s education and telemedical support with visual wound healing monitoring and video conversations have the potential to minimize the number of unnecessary in-person visits in patients with wounds and therefore substantially increase the level of care.

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