The presence of anemia in patients with leg ulcer: laboratory test

ABSTRACT Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

Mobile Health App for Chronic Wound Management (Preprint)

BACKGROUND Chronic ulcers, and especially ulcers affecting the lower extremities and their protracted evolution, are a health problem with significant socio-economic repercussions. The patient's quality of life often deteriorates, leading to serious personal problems for the patient and, in turn, major care challenges for healthcare professionals. Our study proposes a new approach for assisting wound assessment and criticality with an integrated framework based on a Mobile App and a Cloud platform, supporting the practitioner and optimising organisational processes. This framework, called Clinicgram, uses a decision-making support method, such as morphological analysis of wounds and artificial intelligence algorithms for feature classification and a system for matching similar cases via an easily accessible and user-friendly mobile app, and assesses the clinician to choose the best treatment. OBJECTIVE The main objective of this work is to evaluate the impact of the incorporation of Clinicgram, a mobile App and a Cloud platform with Artificial Intelligence algorithms to help the clinician as a decision support system to assess and evaluate correct treatments. Second objective evaluates how the professional can benefit from this technology into the real clinical practice, how it impacts patient care and how the organisation’s resources can be optimised. METHODS Clinicgram application and framework is a non-radiological clinical imaging management tool that is incorporated into clinical practice. The tool will also enable the execution of the different algorithms intended for assessment in this study. With the use of computer vision and supervised learning techniques, different algorithms are implemented to simplify a practitioner's task of assessment and anomaly spotting in clinical cases. Determining the area of interest of the case automatically and using it to assess different wound characteristics such as area calculation and tissue classification, and detecting different signs of infection. An observational and an objective study have been carried out that will allow obtaining clear indicators of the level of usability in clinical practice. RESULTS A total of 2,750 wound pictures were taken by 10 nurses for analysis during the study from January 2018 to November 2021. Objective results have been obtained from the use and management of the application, important feedback from professionals with a score of 5.55 out of 7 according to the mHealth App Usability Questionnaire. It has also been possible to collect the most present type of wound according to Resvech 2.0 of between 6 and 16 points of severity, and highlight the collection of images of between 0 and 16 cm2 of area 88%, with involvement of subcutaneous tissue 53.21%, with the presence of granulated tissue 59.16% and necrotic 30.29% and with a wet wound bed 61.54%. The usage of app to upload samples increase from 31 to 110 samples per month from 2018 to 2021. CONCLUSIONS Our real-world assessment demonstrates the effectiveness and reliability of the wound assessment system, increasing professional efficiency, reducing data collection time during the visit and optimising costs-effectivity in the healthcare organisation by reducing treatment variability. Also, the comfort of the professional and patient. Incorporating a tool such as Clinicgram into the chronic wound assessment and monitoring process adds value, reduction of errors and improves both the clinical practice process time, while also improving decision-making by the professional and consequently having a positive impact on the patient's wound healing process.

Practicality of Wound Detection Using Smartphone Measure App

The record of the pressure sore with photo needs to be measurable. We compare the time consumption of wound assessment ruler and measure application of smartphone and the satisfaction of the users. The time needed is 20 and 35 seconds for the ruler and the application on average. But the satisfaction is better for application for its convenience, less infection, and the accuracy of measurements.

Automatic Robot-Driven 3D Reconstruction System for Chronic Wounds

Chronic wounds, or wounds that are not healing properly, are a worldwide health problem that affect the global economy and population. Alongside with aging of the population, increasing obesity and diabetes patients, we can assume that costs of chronic wound healing will be even higher. Wound assessment should be fast and accurate in order to reduce the possible complications, and therefore shorten the wound healing process. Contact methods often used by medical experts have drawbacks that are easily overcome by non-contact methods like image analysis, where wound analysis is fully or partially automated. This paper describes an automatic wound recording system build upon 7 DoF robot arm with attached RGB-D camera and high precision 3D scanner. The developed system presents a novel NBV algorithm that utilizes surface-based approach based on surface point density and discontinuity detection. The system was evaluated on multiple wounds located on medical models as well as on real patents recorded in clinical medical center.

Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.

FACIAL WOUND ASSESSMENT KIT

Facial wounds are a frequent reason for emergency room visits. The goals of laceration repair are to achieve hemostasis, avoid infection, restore function to the involved tissues, and achieve optimal cosmetic results with minimal scarring. Therefore, these cases are most appropriately managed by plastic surgeons who have a thorough knowledge of anatomy, aesthetic sense, and meticulous expertise in atraumatic tissue manipulation, combined with the surgical skill to repair any structure. You need to know what to do and what not to do : whether to suture or leave open. What local anesthesia to use and how. What equipment to use (and have it available beforehand). Whether to give antibiotic therapy and what kind. How to avoid aesthetic or functional after-effects. Which dressing to use depending on the state of the wound. This article will serve as an aid to wound management and review repair techniques for high-risk areas of the face.

Extracellular matrix and cellular senescence in venous leg ulcers

High prevalence of non-healing chronic wounds contributes to a huge healthcare burden across the world. Early treatment interventions for non-healing wounds are vital. It was previously shown that accumulation of 15% or more of senescent cells in a chronic wound edge is an indicator that the wound is unlikely to heal. However, determining the presence of senescent cells would require invasive procedures such as tissue biopsies to be taken. In this study, we found a strong correlation between decreased collagen area and presence of senescent cells in human chronic wounds i.e. venous leg ulcer (VLU), diabetic foot ulcer (DFU) and pressure ulcer (PRU). We also report that the lowest collagen levels were found in VLU patients less than 60 years of age, with a persistent wound of > 24 months. Elevated levels of senescent cells were also found in VLU of males. Second harmonic imaging of collagen at the edge of chronic wounds with a handheld multiphoton device could be used to predict the number of senescent cells, indicating if the wound is on a healing trajectory or not. Our data support the use of collagen imaging in cutaneous wound assessment for a faster and non-invasive method to predict cellular senescence and determining wound trajectory of healing.

Legalities in All Wound Care Negligence of Care

Wound care costs in the United States exceeds 10 times more than that of other countries.1 Legal suites are increasingly paid out by clinicians, not the hospitals or the healthcare system.2 Many clinicians are facing lawsuits for malpractice or professional neglect. When taken to court and found guilty, the judgment will result in a large settlement then include the loss of the clinician’s license.1 Since malpractice has a limited judgement, many lawyers are seeking damages as a result of elder abuse. In using elder abuse, the judgements do not have a limitation and often result in very large settlements.2 Clinicians need to learn how to protect him/herself from lawsuits and present the best defense. Areas of negligences in care are: 1) Failure to follow the provider’s orders. 2) Failure to properly monitor and observe the patient and the progress of the wound, 3) Failure to report changes in the patient’s condition. 4) Failure to properly document wound assessment properly and with true description.2