Editorial Staff

Editor Barbara Zeiger

Assistant Editor Lauren Mateja

Web Content Coordinator Katherine Blessing

Editorial Correspondence

Barbara Zeiger, Editor, OWM

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August 2012 | Volume 58 - Issue 8

Construction and Use of Wound Care Guidelines: An Overview

Abstract

  Patients should receive care based on the best available scientific knowledge. Clinical wound care guidelines have been created using many methodologies, but many remain consensus-based. A consensus-based approach is no longer considered adequate or appropriate. The best guidelines are developed from a systematic examination and appraisal of good evidence from well-conducted trials. The development process must be transparent, utilize an accepted evidence rating system, be supported by appropriate clinical expertise, and lead to unambiguous recommendations. Prospective validation studies are important as part of the development process, especially for areas of care with limited literature-based evidence. Wound care will become a process of applying the best data available to the clinical situation. The ultimate use of guidelines will be the development of evidence-based, validated clinical tools that can be integrated with existing patient data and available to the wound care professional at the consultation....

Using Temperature of Pressure-related Intact Discolored Areas of Skin to Detect Deep Tissue Injury: An Observational, Retrospective, Correlational Study

Abstract

  Pressure-related intact discolored areas of skin (PRIDAS) are generally described as an area of nonblanching erythema (Stage I pressure ulcer) or deep tissue injury (DTI), but the validity of these definitions has not been tested. Preclinical studies and forensic observations have shown that skin temperature may help identify nonviable tissue. To investigate the effect of temperature difference between a PRIDAS and its adjacent intact skin and the subsequent development of skin necrosis, an observational, retrospective, correlational study was conducted. Data from all acute care hospital patients with an observed PRIDAS who received a skin integrity consult, including a skin temperature measurement of a PRIDAS site, were abstracted to ascertain if PRIDAS temperature correlated with the development of skin necrosis after 7 to 14 days and to examine the effect of additional patient variables on the progression or resolution of a PRIDAS. ...

Guest Editorial: “Skin Failure” as a Cause of Pressure Ulcers: Accurate Terminology, Misnomer, or Cop Out?

  Many in the wound care community use the term skin failure to suggest a cause for the development of a pressure ulcer. I respectfully challenge the term in that context.

  In the May 2012 issue of Ostomy Wound Management,1 the authors of “A Prospective, Descriptive Study of Characteristics Associated With Skin Failure in Critically Ill Adults” stated, “Critically ill patients with multi-organ failure are especially susceptible to problems with skin integrity, including skin failure. These patients frequently have alterations in tissue perfusion and, because of their failed organs, are unable to maintain homeostasis. This may lead to the death of the skin and underlying structures.” The key terms here are susceptible and tissue perfusion. I agree skin is susceptible to pressure ulcers, but in this context, skin rarely dies without pressure. This article defines skin failure as “an event in which skin and underlying tissues die due to hypoperfusion concurrent with critical illness.” I challenge this definition by asking, Where does the skin die? A similar question may be asked regarding the Kennedy Terminal Ulcer.2 In true skin failure, it would be reasonable to expect to see dying skin over any part of the body. However, in most of the literature, when the term skin failure is used in relation to pressure ulcers, almost all of the “skin failures” are over pressure points....

Nutrition 411: Diabetes and Wounds: Weight Loss as a Preventative Strategy

  Self-management of diabetes often is a daunting prospect for patients, particularly when newly diagnosed. Hearing they must test blood sugar, follow a new diet, engage in physical activity, take medications appropriately, and be concerned with comorbidity complications can be overwhelming. Although healthcare professionals (HCPs) are aware of the dangers of uncontrolled diabetes, patients often are not concerned until detrimental symptoms, such as a wound, occur. Diabetes and wounds is a dangerous combination; a wound is never simple for a patient with diabetes. According to the American Diabetes Association,1 25.8 million people in the United States have diabetes; currently, it is the sixth leading cause of death....

Continence Coach: Opportunities for Mixed-Method Designs in Nursing Research

  Despite growing interest in the integration of qualitative and quantitative designs (ie, mixed-method) in healthcare research, no major health services journal has devoted an entire issue to the topic. This is about to change. The December 2013 issue of Health Services Research is partnering with the federal Agency for Healthcare Research and Quality (AHRQ), calling for papers that use mixed-method research to spotlight the implementation and effects of recent changes in healthcare delivery. The aim of the special issue is to enhance researcher, funder, and policy maker understanding of how the methodology can be applied to enrich, and to promote its expanded use specifically in, health services research. Papers that illustrate examples of care delivery design, payment, and reporting are being sought. This initiative should be of particular interest to the majority of readers of OWM, because in past decades nursing research has been dominated by quantitative studies in pursuit of “the science” of healthcare....

My Scope of Practice: Seeking Challenging Paths

Do not follow where the path may lead. Go instead where there is no path and leave a trail. — Ralph Waldo Emerson

  "Nursing is a demanding job,” says Michelle C. Quigel, BSN, RN, CWOCN. “WOC nursing is even harder. It’s not for the meek or mild.” With more than 20 years as a WOC nurse under her proverbial cap, Michelle tackles every day, and every patient, with the ease and familiarity of a veteran. But despite her success in her chosen field, Michelle isn’t resting on her laurels. She continues to test new products, review new procedures, and do all she can to improve wound, ostomy, and continence care. ...

AAWC Update

AAWC and DebRA Join Forces

  The Association for the Advancement of Wound Care (AAWC) and the Dystrophic Epidermolysis Bullosa Research Association of America (DebRA) are working together to bring wound care professionals where they’re needed most — to patients and families living with Epidermolysis Bullosa (EB)....

Quality of Pediatric Second-degree Burn Wound Scars Following the Application of Basic Fibroblast Growth Factor: Results of a Randomized, Controlled Pilot Study

Abstract

  Pediatric burn wounds present unique challenges. Second-degree burns may increase in size and depth, raising concerns about healing and long-term scarring. Results of a clinical study in adults with second-degree burn wounds suggest that application of basic fibroblast growth factor (bFGF) may reduce time to second-intention healing and result in a more cosmetically acceptable scar. To evaluate the effect of this treatment on pediatric patients with deep second-degree burn wounds, 20 pediatric patients ranging in age from 8 months to 3 years (average 1 year, 3 months [± 6 months]) with a total of 30 burn wounds from various causes were allocated either the growth factor (treatment, n = 15) or an impregnated gauze treatment (control, n = 15). Wounds still exudative (not healed) after 21 days were covered with a split-thickness skin graft. All wounds were clinically assessed until healed and after 1 year. A moisture meter was used to assess scars of wounds healing by secondary intention. A color meter was used to evaluate grafted wounds. Five wounds in each group required grafting. Skin/scar color match was significantly closer to 100% in the treatment than in the control group (P <0.01). {C}...