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  • 1
    Electronic Resource
    Electronic Resource
    Diabetic foot ulcers: A framework for prevention and care (1999)
    Oxford, UK : Blackwell Science Inc
    Wound repair and regeneration 7 (1999), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Complications secondary to diabetes, such as diabetic foot ulcers, continue to be a major worldwide health problem. At the same time, health care systems are changing rapidly, causing concern about the quality of patient care. While the ultimate effect of current changes on health care professionals and patient outcomes remain uncertain, measures commonly used to reduce costs, e.g., disease and multi discliplinary management strategies, have been shown to help prevent the occurrence of diabetic ulcers. In addition, ultilizing a multi discliplinary approach, the principles of off-loading and optimal wound care, the vast majority of diabetic foot ulcers can be expected to heal within 12 weeks of treatment. Education of primary care providers and patients is paramount. (WOUND REP REG 1999;7:7–16)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-475x.1999.00007.x
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  • 2
    Electronic Resource
    Electronic Resource
    129
Mist-Assisted Healing: The Use of MIST™ Ultrasound for Wound Bed Preparation Prior to the Use of Bioengineered Tissue (Apligraf®) (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The understanding of bioengineered tissue has evolved over the past 5 years. Now considered “cell therapy,” bioengineered tissue can provide a nonhealing wound with the appropriate complement of cytokines, growth factors, and healthy cells to promote the patient’s healing process. As clinicians have gained experience with Apligraf*, the process of wound bed preparation has proven to be a critical step in order to achieve optimal outcomes with the tissue construct. Recently, the investigators have evaluated a novel device, MIST† ultrasound , recently FDA cleared for the cleansing and debriding of wounds. A subgroup from a total of 23 patients in a research trial using MIST therapy for nonhealing wounds received an Apligraf as part of their treatment regimen. The'bioengineered tissue remained intact for a full 4 weeks postapplication and the appearance of the graft was quite different than our prior experience with the product. On removal of the wound/graft eschar, patients had achieved complete epithelialization. This report describes the patients who underwent this combination of technologies along with wound photographs, measurements and patient histories. As we learn more about the biochemistry of healing we are able to “look” at how we combine and use advanced wound care technologies.Acknowledgments:  This study was supported from a grant from Celleration Inc.Product notation: * Apligraf® is a registered trademark of Novartis, Inc., East Hanover, NJ © 2004 Organogenesis, Inc., Canton, MA † MIST™ ultrasound is a registered trademark of Celleration Inc., Eden Prairie, MN.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130216ag.x
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  • 3
    Electronic Resource
    Electronic Resource
    169
Pressure Ulcer Prevention: An Aggressive Quality Improvement Initiative Centered on a Hospital-Wide Bed Replacement Program- (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Advocate Christ hospital is a 650-bed, level-one tertiary-care center that created a comprehensive wound care program in November 1998. Over the first 3 years of the program there were over 140 admissions per year directly from the wound center along with numerous hospital to hospital transfers for complex wound management. Prevalence rates therefore increased linearly over this time frame. The wound team calculated a system-wide (eight hospitals) spend of $2.1 million per year for specialty rental beds. Incidence rates for the system were at, but not lower than, national levels despite the high cost incurred. A $1.3 million capital purchase for KCI atmos-air 9000/〉 mattresses resulted in the complete replacement of all medical surgical beds in all eight hospitals. An internal prevalence and incidence team was created and data were collected both at the hospital and system-wide level on a quarterly basis. Hospital and system incidence rates fell to or below 7%(targeted goal) and the entire project will achieve a return on investment in 18 months. Data to be presented include prevalence and incidence results, rental bed costs pre- and postbed purchase, and a detailed review of the process of creating an electronic prevalence and incidence tracking system.Acknowledgments:  This study was not supported by any outside grants.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130216bu.x
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  • 4
    Electronic Resource
    Electronic Resource
    125
“MIST Ultrasound Therapy for Recalcitrant Wounds, A new approach” (2004)
    Oxford, UK; Malden, USA : Blackwell Science Ltd/Inc.
    Wound repair and regeneration 12 (2004), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The use of adjunctive peri-wound, ultrasound with either a 1 MgHz or 3 MgHz frequency has been reported on in the literature with variable results. MIST ultrasound therapy is a novel application of direct wound bed application of kilohertz ultrasound waves utilizing a normal saline mist as the coupling mechanism, allowing for no direct patient contact. The mist generated by the system is of relative uniform particle size and acts as a conduit of ultrasound energy. Unlike ultrasonic baths, which dissipate the vibrational energy over a large area, the transducer horn focuses the energy into a smaller area of application.The MIST™ system consists of an ultrasonic power supply (generator), a transducer (or alternately referred to as the converter), and an applicator coupled to the transducer. The generator converts voltage to high frequency electrical energy. This electrical energy is transmitted to the piezoelectric transducer within the converter, where it is changed to mechanical vibrations. The generator is designed to operate the converter at 40 kHz with a distal displacement of 60 microns. Published reports have described various biological effects of low frequency ultrasound including VEGF and PDGF production, increased protein synthesis, improved bone and wound healing. Other authors have published abstracts demonstrating clinical efficacy of this device on a broad range of patients with recalcitrant wounds. This report describes the clinical results of a prospective, non-randomized, efficacy trial, adding MIST ultrasound therapy to current treatment protocols in recalcitrant wounds. Wound healing trajectories before and after treatment will be evaluated and wound healing will be assessed with laser Doppler image analysis and trans-cutaneous oximetry.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2004.0abstractds.x
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  • 5
    Electronic Resource
    Electronic Resource
    036
MIST Ultrasound: The results of a multicenter, randomized, double-blind, sham-controlled trial of the healing of diabetic foot ulcers (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A prospective, randomized, sham-controlled, double-blinded study of diabetic foot ulcers was conducted to answer questions of safety and impact on wound healing of a noncontact ultrasound device. Standard of care included moist dressings, debridement, offloading, and adequacy vascular supply for both groups. Patients were randomized to receive a saline mist or 40 KHz ultrasound therapy delivered to the wound bed using the spray as the coupler. The study was 12 weeks in duration or until the wound closed.Sixty-six patients were entered with intent to treat. Fifty-five patients were evaluable and constitute the outcomes of the study. MIST therapy resulted in 42.3% rate of healing versus 14.3% for sham treated significant at 0.028 Chi square. Kaplan Meier survival plots resulted in p 〈 0.0087 log rank and p 〈 0.011 Wilcoxon. Rate of wound closure was 22% faster with MIST compared to sham treated patients. There was no statistically significant difference with regard to adverse events in any category (mild, moderate, or severe) MIST ultrasound therapy is a new, safe, novel FDA-cleared device that improves diabetic foot ulcer healing compared to standard of care. Details of the study will be presented.Acknowledgments:  This study was funded by Celleration Inc. Eden Prairie, MN.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130215aj.x
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  • 6
    Electronic Resource
    Electronic Resource
    146
Mist Ultrasound: The Results of a Prospective, Non-Randomized Efficacy Study of Recalcitrant Wounds (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: MIST ultrasound, a recently FDA-cleared noncontact ultrasound therapy, was utilized prospectively in an IRB-approved trial for the treatment of recalcitrant wounds of various etiologies. Twenty-nine wounds from 23 patients were studied. Inclusion criteria included wounds greater than 4 weeks duration with no evidence of clinical improvement (〉15% area reduction) over the prior 2 weeks before enrollment. The wounds were required to be free from clinical signs of infection. After an initial debridement and wash-out period, patients were treated 3 times a week with MIST for 4 minute treatment applications. Dressing regimens were left up to the investigator as dictated by wound conditions. The primary endpoint is complete healing. Data will be presented looking at MIST-derived healing, as defined by complete healing using MIST therapy all the way to closure. MIST-assisted healing, as defined by MIST therapy for wound bed preparation followed by an alternative means of closure will also be presented. “Overall healing” defined by the combination of the two prior groups will complete the outcomes report, as this reflects a more “real-world” clinical application for the technology. Wound dynamics, Kaplan Meier survival plots and laser Doppler imaging estimations of angiogenesis will all be presented.Acknowledgment:  This study was supported with a grant from Celleration Inc., Eden Prairie, MN.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130216ax.x
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  • 7
    Electronic Resource
    Electronic Resource
    099
Returning Skin and Wound Care to the Bedside: One Hospital’s Journey Through Process Improvement (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: An initiative to bring wound care “back to the bedside” was introduced in a large teaching hospital. Wound consultation was available from either a nurse or physician member of a hospital-based wound team. Confusion over whom to consult coupled with multiple product options led to decreased critical thinking at the bedside. The volume of consultations precluded follow-up visits by the team, further fragmenting care.The proposed solution included partnering with a sole vendor to standardize wound products and assist with education on product selection and function. New policies and procedures were created. Each patient unit was staffed by a Nurse clinical specialist as part of a hospital-wide “Magnet” application process. This individual assumed the role of “skin care leader” and was required to attend two in-depth educational programs. All skin care leaders were required to become part of a hospital-wide quarterly prevalence and incidence project. The wound nurse assumed a more “consultative” role for the skin care leaders who subsequently assisted the end user in this model; the bedside nurse.This paradigm shift in care did not result in any statistically significant changes in wound incidence and reintroduced skin care as an integral component of the assessment and care for the bedside nurse. This presentation will describe the process in detail.Acknowledgments:  This study was supported with an educational grant from Smith and Nephew, Largo, FL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130216c.x
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  • 8
    Electronic Resource
    Electronic Resource
    100
Transitioning Care from Curative to Palliative Does not Mean Abandoning Advanced Wound Care: Experiences from an Advanced SubAcute Wound Care Unit (2005)
    Oxford, UK; Malden, USA : Blackwell Publishing Ltd/Inc.
    Wound repair and regeneration 13 (2005), S. 0 
    Details
    ISSN: 1524-475X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: It is expected that by 2030, 20% of the American population will be over 65 years of age. Forty percent of Americans are expected to die in nursing homes in the near future. Pressure ulcer prevalence rates of 13% are reported at long-term care units but healing rates are infrequently published from these settings. Current wound protocols fail to consider patients goals of care. The possibility that a wound will not heal is rarely communicated to the patient or family.Palliative care focuses on the relief of suffering and improvement in the quality of life. It can be the sole focus of care or can be delivered parallel to aggressive curative treatments.This presentation describes a case history of an unfortunate 40-year-old patient suffering from multiple sclerosis who developed a stage 4 pressure ulcer during a pregnancy. Postpartum, the patient underwent flap coverage of the wound. Her MS worsened, the flap broke down and a family conference resulted in the decision to provide palliative wound care and involve hospice. Wound care continued with a silver impregnated absorptive dressings and ultraviolet light therapy to control bioburden, diminish odor and dressing frequency, which improved quality of life. Palliative wound protocols will be reviewed along with details of the above-mentioned case.Acknowledgments:  This presentation was supported with an educational grant from Smith and Nephew, Largo, FL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1067-1927.2005.130216d.x
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  • 9
    Electronic Resource
    Electronic Resource
    A 31P NMR study of extracted phospholipid composition of human skin: full thickness skin, dermis, epidermis and granulation tissue (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Skin research and technology 4 (1998), S. 0 
    Details
    ISSN: 1600-0846
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background/aims: Phospholipids are the most important component of the plasma membrane in skin cells. Until recently, skin phospholipids have only been studied by chromatography and those results need confirmation by other methods such as 31PNMR spectroscopy.Methods: Phospholipid profiles were analyzed from human skin and granulation tissue using 31PNMR spectroscopy. Skin samples were taken from lower extremity amputation specimens and from one healthy volunteer. The granulation tissue was obtained from the wound bed of venous stasis ulcers, pressure ulcers and post-op non-healing surgical wounds. Phospholipid extractions were performed on full thickness skin samples (excluding the subcutaneous layer), epidermis, dermis, and granulation tissue biopsies.Results: Twelve phospholipid species were detected in each of the groups studied: PA, CL, DHSM, Eplas, PE, PS, SM, LPC, PI, AAPC, and PC. Statistically significant differences were found between epidermis and full thickness skin in relation to the quantity of PA, CL, DHSM, LPC, AAPC, and PC. The phospholipid ratio [(PE+Eplas+PI+PA)/PC] was calculated for each group: the epidermis value was 1.30, the dermis value was 0.62 and full thickness skin value was 0.49.Conclusions: These phospholipid profiles present a very unique distribution, which correlates with the physiological activity of the individual layer. The study of the phospholipid profile of granulation tissue opens a new line of research, evaluating changes in these profiles during the various phases of wound healing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-0846.1998.tb00089.x
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