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Wound Management
Wound management encompasses all clinicians with a specialty in healing acute, infected, and chronic wounds.
Wound Management: Using Levine?s Conservation Model to Guide Practice
Effective wound management is needed not only to generate positive patient outcomes, but also to reduce healthcare expenditure and demand on healthcare services. Implementing Levine?s four-principled conservation model ? which addresses conservation of energy, structural integrity, personal integrity, and social integrity ? can provide clinical and financial benefits, as illustrated in the care of venous leg ulceration. Using Levine?s model as a theoretical framework for wound management also can contribute to good nursing practices, enhancing a care approach that embraces wholeness and health along with cost effective care. Understanding how Levine?s model can improve patient care is further elucidated by discussing each of the principles in relation to wound management.
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Hydrogel Wound Dressings: Where Do We Stand in 2003?
Among the many categories of advanced wound dressing products available today, hydrogels are popular because they are effective, comfortable, easy to use, and cost effective. With proper use, these agents provide control of wound surface hydration, sometimes absorbing excess exudate and often providing moisture. This review describes the chemistry of hydrogels, the physiology of their interaction with the wound surface, and their role in patient care. Hydrogels have been proven effective in facilitating repair of pressure, diabetic, vascular, burn, and other wounds, and they have supplanted saline-moistened gauze for many applications. Clinical evidence suggests that no particular hydrogel is significantly more efficacious than any other, implying that other factors such as cost and ease of use may guide clinician choice of product within this class of wound dressings.
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Industry News for August 2003
The new enterprise enables healthcare providers to get better results from their wound management programs. This program is currently available to healthcare providers nationwide. SilvaSorb, the sterile, single-use dressing is intended for moist wound management.
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A Consensus Report on the Use of Vacuum-Assisted Closure in Chronic, Difficult-to-Heal Wounds
Vacuum-assisted closure is an adjunctive therapy that utilizes negative pressure to remove fluid from open wounds through a sealed dressing and tubing which is connected to a collection container. Although introduced into practice for individuals with chronic wounds, evidence to support its use is limited. To compensate for the current gap between the evidence base and the need for best vacuum-assisted closure practices in the treatment of chronic wounds, the existing evidence base (case reports, case series, and studies) for pressure ulcers, diabetic foot ulcers, heel ulcers, and venous leg ulcers was retrieved and tabulated from relevant literature in PubMed and other sources. In addition, expert opinion was obtained through an 11-member Delphi panel of interdisciplinary wound care opinion leaders and educators. The panel included frequent (6) and less-frequent (5) vacuum-assisted closure users. The tabulated responses and the existing literature formed the basis of the best practice statements that serve to guide treatment approaches and stimulate further study.
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Bacterial Toxins and Wound Healing
Infection - a factor commonly related to delayed closure for many chronic and acute wounds - is associated with relatively high levels of bacteria in viable tissues. But bacteria also can delay wound healing at lower levels before tissue invasion via toxin secretion either directly from viable cells (exotoxins) or as a result of cell lysis (endotoxins). These toxins tend to cause local necrosis and disrupt the delicate balance of critical mediators such as cytokines and proteases necessary for healing progression. Therefore, toxin control or absorption is a potentially valuable adjunct to any infection control modality. A long-standing method of controlling toxins of many types is the use of high surface area adsorbents, such as activated charcoal. Recent data suggest that activated charcoal may offer specific advantages in topical wound management through its effects on bacterial toxins.
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Using Horsechestnut Seed Extract in the Treatment of Venous Leg Ulcers: A Cost-Benefit Analysis
Venous leg ulcers affect approximately 0.6% of the western population, consuming millions of healthcare dollars every year. To determine whether an alternative venous ulcer treatment using horsechestnut seed extract ? Aesculus hippocastanum? and conventional therapy involving dressings and compression was more cost-effective than using conventional therapy alone, a 12-week cost-benefit analysis of horsechestnut seed extract therapy was conducted. The study, using data from a 12-week prospective, randomized, placebo-controlled trial conducted in South Australia in 2002?2004, involved 54 patients with venous ulceration who received treatment through a large South Australian district nursing service. Taking into account the cost of horsechestnut seed extract, dressing materials, travel, staff salaries, and infrastructure for each patient, horsechestnut seed extract therapy combined with conventional therapy was found to be more cost-effective than conventional therapy alone with an average savings of AUD $95 in organizational costs and AUD $10 in dressing materials per patient. This study confirms that dressing change frequency has a significant impact on the total cost of wound care and suggests that district nursing service operation efficiency may be enhanced through the use of horsechestnut seed extract as a result of less frequent nursing visits. Further study of this treatment modality is warranted.
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Pain in Fungating Wounds: Another Perspective
This article is adapted from Naylor W. Assessment and management of pain in fungating wounds. British Journal of Nursing. 2001;(suppl);10(22)
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Championing the Podiatrist's Role in Wound Care
He learned a few training tricks along the way. For Dr. Snyder, a collaborative approach to wound healing is a major priority, and understanding wound etiologies and science is key to healing recalcitrant wounds. Dr. Snyder often teaches about new wound care technologies as adjuncts to good wound care practices.
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A Pain Management Protocol for Wound Care
Perhaps the strongest motivator for addressing the pain patients experience is moral imperative. The NHS Pain Management Protocol, referenced in the treatment/management portion of the wound pain protocol, includes the World Health Organization? Specific dressing and wound management options are suggested to address the cyclic acute pain associated with dressing ...
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Evaluating the Efficacy of a Uniquely Delivered Skin Protectant and Its Effect on the Formation of Sacral/Buttock Pressure Ulcers
Skin breakdown is a common adverse occurrence in healthcare facilities; effective management of related risk factors is critical for prevention. Measures focusing on the skin care of patients with incontinence are recommended to reduce the incidence of pressure ulcers on the sacrum and ischium. However, little research exists to support these recommendations. A retrospective study was conducted to determine if the use of a skin cleansing/protectant product on residents with incontinence decreased the incidence of nosocomial pressure ulcers in the sacral/buttock area. Chart data from all residents with incontinence of a 57-bed, long-term care, skilled nursing home that employs a comprehensive approach to pressure ulcer prevention were collected for a period of 3 months before use of the new product and for 3 months following introduction of the new product. During the first 3 months, five (14.7%) of the 34 incontinent residents developed superficial pressure ulcers (20% were Stage I, 80% were Stage II). Following the change in skin care, no pressure ulcers occurred in the 30 residents with incontinence. The observed decrease (McNemar's chi-square = 4.786, df = 1, Phi = -.273, P = .015) suggests a significant association between the consistent application of a skin protectant and the prevention of skin breakdown. The results of this study demonstrate that, in this population, and in the presence of a comprehensive pressure ulcer prevention program, use of this skin protectant can significantly reduce the incidence of nosocomial sacral/buttocks pressure ulcers.
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