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Wound Repair and Regeneration :... Jan 2019Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the...
Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard-to-heal, or having led to an amputation. The review excluded studies that did not present data on generic health-related quality of life and/or cost data, case studies, randomized controlled trials, economic modeling studies, abstracts, and editorials. Extracted data were summarized into a narrative synthesis, and for a few articles using the same health-related quality of life instrument, average estimates with 95% confidence intervals were calculated. Thirty articles met the inclusion criteria. Findings revealed that health-related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound-related amputations. The cost burden was mainly attributed to amputations for patients also comorbid with diabetes, where the cost for hospitalization ranged from US$12,851 to US$16,267 (median) for this patient group. Patients with chronic wounds have poor health-related quality of life in general and wound-related costs are substantial. Development and implementation of wound management strategies that focus on increasing health-related quality of life and effectively reduce costs for this patient group are urgently needed.
Topics: Chronic Disease; Cost of Illness; Health Care Costs; Humans; Quality of Life; Wound Healing; Wounds and Injuries
PubMed: 30362646
DOI: 10.1111/wrr.12683 -
Critical Care Clinics Jan 2017Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic... (Review)
Review
Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic resuscitation of bleeding injured patients. This article describes the role of TEG in contemporary trauma care by explaining this assay's methodology, clinical applications, and result interpretation through description of supporting studies to provide the reader with an evidence-based user's guide. Although TEG and ROTEM are assays based on the same viscoelastic principle, this article is focused on data supporting the use of TEG in trauma, because it is available in trauma centers in North America; ROTEM is mostly available in Europe.
Topics: Blood Coagulation Disorders; Europe; Humans; North America; Practice Guidelines as Topic; Thrombelastography; Wounds and Injuries
PubMed: 27894492
DOI: 10.1016/j.ccc.2016.09.002 -
Journal of Visualized Experiments : JoVE May 2013Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound...
Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans.
Topics: Animals; Male; Mice; Mice, Inbred C57BL; Models, Animal; Skin; Wound Healing; Wounds and Injuries
PubMed: 23748713
DOI: 10.3791/50265 -
Chest Mar 2019Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and... (Review)
Review
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
Topics: Bronchi; Conservative Treatment; Humans; Minimally Invasive Surgical Procedures; Patient Selection; Stents; Trachea; Wounds and Injuries
PubMed: 30059680
DOI: 10.1016/j.chest.2018.07.018 -
Current Problems in Surgery Jul 2014The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is... (Review)
Review
The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
Topics: Bandages; Biofilms; Cell- and Tissue-Based Therapy; Female; Humans; Male; Negative-Pressure Wound Therapy; Occlusive Dressings; Suction; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 24935079
DOI: 10.1067/j.cpsurg.2014.04.001 -
Journal of Wound Care Sep 2016
Topics: Awards and Prizes; Congresses as Topic; Humans; Skin Care; Wound Healing; Wounds and Injuries
PubMed: 27608510
DOI: 10.12968/jowc.2016.25.9.497 -
Value in Health : the Journal of the... Jan 2018The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.
OBJECTIVE
The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.
METHODS
This retrospective analysis of the Medicare 5% Limited Data Set for calendar year 2014 included beneficiaries who experienced episodes of care for one or more of the following: arterial ulcers, chronic ulcers, diabetic foot ulcers, diabetic infections, pressure ulcers, skin disorders, skin infections, surgical wounds, surgical infections, traumatic wounds, venous ulcers, or venous infections. The main outcomes were the prevalence of each wound type, Medicare expenditure for each wound type and aggregate, and expenditure by type of service.
RESULTS
Nearly 15% of Medicare beneficiaries (8.2 million) had at least one type of wound or infection (not pneumonia). Surgical infections were the largest prevalence category (4.0%), followed by diabetic infections (3.4%). Total Medicare spending estimates for all wound types ranged from $28.1 to $96.8 billion. Including infection costs, the most expensive estimates were for surgical wounds ($11.7, $13.1, and $38.3 billion), followed by diabetic foot ulcers ($6.2, $6.9, and $18.7 billion,). The highest cost estimates in regard to site of service were for hospital outpatients ($9.9-$35.8 billion), followed by hospital inpatients ($5.0-$24.3 billion).
CONCLUSIONS
Medicare expenditures related to wound care are far greater than previously recognized, with care occurring largely in outpatient settings. The data could be used to develop more appropriate quality measures and reimbursement models, which are needed for better health outcomes and smarter spending for this growing population.
Topics: Aged; Chronic Disease; Cost-Benefit Analysis; Female; Health Policy; Humans; Male; Medicare; Retrospective Studies; United States; Wounds and Injuries
PubMed: 29304937
DOI: 10.1016/j.jval.2017.07.007 -
Journal of Wound Care Sep 2017
Topics: Biomarkers; Biopsy; Exudates and Transudates; Humans; Wounds and Injuries
PubMed: 28880751
DOI: 10.12968/jowc.2017.26.Sup9.S3 -
Journal of Wound Care Mar 2020
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages; Biofilms; Debridement; Detergents; Early Medical Intervention; Humans; Pain Management; Practice Guidelines as Topic; Skin; Surface-Active Agents; Treatment Failure; Wound Healing; Wounds and Injuries
PubMed: 32160083
DOI: 10.12968/jowc.2020.29.Sup3b.S1 -
Journal of Wound Care Apr 2015Innovation in medicine requires unique partnerships between academic research, biotech or pharmaceutical companies, and health-care providers. While innovation in... (Review)
Review
Innovation in medicine requires unique partnerships between academic research, biotech or pharmaceutical companies, and health-care providers. While innovation in medicine has greatly increased over the past 100 years, innovation in wound care has been slow, despite the fact that chronic wounds are a global health challenge where there is a need for technical, process and social innovation. While novel partnerships between research and the health-care system have been created, we still have much to learn about wound care and the wound-healing processes.
Topics: Chronic Disease; Diffusion of Innovation; Humans; Translational Research, Biomedical; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 25853643
DOI: 10.12968/jowc.2015.24.Sup4b.7