Day 2 :
Keynote Forum
Michele Burdette Taylor
University of Alaska Anchorage| USA
Keynote: Circumpolar health among indigenous inuit population
Time : 09:30-10:15
Biography:
Michele Burdette-Taylor has completed her PhD at the University of San Diego in California. She is an assistant professor at the University of Alaska Anchorage. She teaches undergraduate and graduate courses in community health, foot care, and wound care for the college of health, school of nursing and physician assistant program. She has published numerous skin, wound, pressure ulcer and foot care articles. Her most recent publication was a chapter for the new Wound Ostomy Continence Nurses Core Curriculum for Wound Care for entitled Foot and Nail Care.
Abstract:
Health in the Arctic among the indigenous circumpolar Inuit population is a serious concern. The Inuit span across four nations. They were descendants from human migrations across the Beringia land bridge 5,000 years ago. There are 167,000 Inuit in Greenland, Denmark, Alaska, Canada and Russia. The research conducted in these regions among this population is unique and directly related to geographic and genetic factors. Geographic remoteness, limited gene pool, and underdeveloped human resources have impacted the health systems and practices.
Chronic diseases as heart disease and diabetes are called “diseases of modernization”. They tend to increase in traditional societies undergoing rapid changes in diet and physical activity. Diabetes, alcoholism, and frostbite are a few concerns of the World Health Organization in reference to global health in the Arctic. Neuropathy leads to foot ulcers, wounds, and amputations are increasing exponentially. Though diabetes is considered a new disease among the Inuit, over the last 2-3 decade glucose tolerance surveys among the Inuit have shown to increase in prevalence.
Global health initiatives have historically excluded indigenous circumpolar concerns. There is much to share from one another. The population of many nations genetically linked over 5,000 years is a priceless resource for learning.
Keynote Forum
Efraim Jaul
Sarah Herzog Hospital | Israel
Keynote: The effect of pressure ulcers on the survival in patients with advanced dementia and comorbidities
Time : 10:15-11:00
Biography:
Efraim Jaul is a specialist in Family Medicine and Geriatric Medicine. He is the Head of the Geriatric Skilled Nursing Department at the Sarah Herzog Hospital, Jerusalem, Israel. It is affiliated with the Hebrew University-Hadassah Medical School, Jerusalem. He is a Clinical Senior Lecturer in the Hebrew Medical School Faculty. He supervises clinical practice and mentors students. He developed and established a pioneering inpatient unit at the Herzog Hospital specifically for the treatment of pressure ulcers concerning the need for a special unit and the resulting benefits for the immobile elderly patients. This unit has elicited interest in serving as a model for geriatric treatment facilities around the world and has set the standard for developing specialized pressure ulcer units
Abstract:
Background: The mortality rates for many leading causes of death have declined over the past decade. Advanced dementia with comorbidities has steadily increased to become one of the leading causes of death in the elderly population. Therefore, we examined the effect of pressure ulcers on the survival time of patients with advanced dementia and comorbidities.
Method: Data was reviewed from all the files of 147 patients hospitalized over a period of three and a half years. 99 tube-fed patients suffering from advanced dementia were included; 72(66.5%) had pressure ulcers and 27(33.5%) were without pressure ulcers at admission. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals for pressure ulcers group versus non-pressure ulcers group. Unadjusted Cox model and Cox proportional Hazards model were used to assess the hazard ratio for pressure ulcers and the association between pressure ulcers and survival time, respectively. Kaplan- Meier model was used to visually confirm the existence of proportional hazards of pressure ulcers on survival.
Results: The median survival of advanced dementia patients with pressure ulcers was significantly shorter, compared to those without pressure ulcers (96 days vs 863 days respectively (p=0.001, log rank test). The Hazard Ratio for the advanced dementia patients with pressure ulcers; was 2.81, 95% CI: 1.51-5.22, p<0.01. Significant lower hemoglobin and serum albumin levels were found in the patients with pressure ulcers; (10.46 vs 11.7 p= 0.001) and (26.2 vs 29.6 p=0.02).
Conclusion: Advance dementia and pressure ulcers in the same patient results in earlier mortality. Advanced dementia patients with pressure ulcers, had significantly lower survival expectancy in comparison to similar patients without pressure ulcers. Clinical and ethical implications are discussed
Panel Discussion
Networking and Refreshment 11:00-11:20 @ Foyer
Keynote Forum
Thomas R. Bernik
Englewood Hospital and Medical Center | USA
Keynote: Current trends in the vascular management of critical limb ischemia
Time : 11:20-12:05
Biography:
Thomas Bernik is Chief of Vascular Surgery at Englewood Hospital and Medical Center in Englewood New Jersey. Bernik specializes in complex open surgery, minimally invasive surgery for aortic aneurysms, carotid disease, peripheral vascular disease and complex venous thrombosis. Most recently Bernik served as Associate Professor of Surgery and Chief of Vascular Surgery at Mount Sinai, Beth Israel, New York. Bernik received his medical degree from George Washington University School of medicine and completed his vascular fellowship at North Shore University as well as Strong Memorial Hospital
Abstract:
Critical limb ischemia comprised of rest pain and tissue loss is a well-known public health issue. The incidence is higher in smokers, diabetics and the elderly. Although there is no clear consensus or randomized trials that support minimal invasive intervention over open surgery, there has been a general trend toward an endovascular first philosophy. The aim of this presentation is to describe current vascular management and supportive data for the treatment of patients with critical limb threatening ischemia. The multiple and various endovascular techniques and approaches will be described as well as case presentations
Keynote Forum
Bipin Puri
Armed Forces Medical Services| India
Keynote: Early burn wound excision: the way to survival
Time : 12:05-12:50
Biography:
Bipin Puri has completed his M Ch in Pediatric Surgery from the Post Graduate Institute of Medical Education & Research, Chandigarh, India in the year 1993. He further completed his Fellowship in Pediatric Urology from Birmingham Children's Hospital, UK in 1997 and is a Fellow of the Royal College of Surgeons (Edinburgh). He is currently the Senior Consultant Surgery for the Armed Forces Medical Services of India, the highest Chair in the faculty of Surgery in the Armed Forces in India. He has 35 publications, 04 International papers and 03 chapters in Medical Text books. He is an examiner for Post Graduate studies with the National Board of Examinations, New Delhi, India, the PGIMER, India, Delhi University and MUHS University, India
Abstract:
Burn injury is a dreaded scourge the world over and indeed is fairly commonly tackled by the military surgeon. While superficial burn wounds heal spontaneously, the deep ones need to be excised and appropriately covered, preferably with autogenous split thickness skin grafts. This result in increased survival, decreased infection rates, and decreased length of hospital stay. However, this standard of care is quite often not offered to the unfortunate patient in the developing world as also in India. We in the Indian Armed Forces have taken the initiative to mitigate the suffering of the soldier and his dependants by this technique and present our 10-year experience in two large burn centers across the country. 622 consecutive patients with deep burn wounds who underwent early excision were included in the study. Average percentage of burned area was 33.09% and average percentage of area excised early in the study group was 20.07%. Maximum area excised at a time in one patient was 45%, with 15 patients excised in excess of 30%. Hospital stay before the early excision was 2.85 days per percent of body surface area burns. After initiation of early burn wound excision, this decreased to 1 day per percent of body surface area burns.
It is indeed a tough challenge to treat patients with major and deep burn wounds. Early excision of burns is far superior to conservative treatment in tackling deep burns. This markedly reduces mortality and significant morbidity in the wounded soldier and the members of his family
- Wound and Wound Care
Wound Care and Ulcers
Skin and Wound Care
Burn Care and Treatment
Anesthesia and Peri-operative Care
Location: Texas C
Chair
Jasmina Begic
University Clinical Center Sarajevo| Bosnia and Herzegovina
Co-Chair
Bipin Puri
Armed Forces Medical Services| India
Session Introduction
Mieczyslawa Franczyk
University of Chicago Medicine| USA
Title: Workshop on Negative Pressure Wound Therapy (NPWT) evolving integration of technology for wound management
Biography:
Mieczyslawa Franczyk has completed her master’s degree in PT and post graduated study for PhD from the University of Physical Education in Poland. She graduated from the University of Illinois Public School of Health. She is a member of the American Physical Therapy Association. She is author or co-author 8 papers, 7 in the arena of subatmospheric pressure wound therapy
Abstract:
The efficacy of Negative Pressure Wound Therapy (NPWT) leading to reduction in wound volume and promotion of wound healing has been well documented in literature (C. Huang et al Current problems in Surgery 51 (2014) 301-331). Negative Pressure Wound Therapy (NPWT) or Sup-Atmospheric Wound Therapy (SAWT) is a term that refers to any devices that applies differential suction to wounds. A number of commercially available devices exist within this definition. Few of the challenges with commercialized equipment used for NPWT are the overall cost and ideal applications in the wound can be very challenging and painful. From a health care providers' standpoint, our obvious interest is to come up with more cost effective, less painful and easy to apply wound closure dressing. In our hospital burn wound and other complex wound care is provided by a physical therapist for last 40 years. NPWT dressing as a new modality for wound management was introduced in 1999. Throughout my 15 years working with NPWT dressing I was confronted with a lot of critically ill patients (more than 300 patients a year) with complex wounds under NPWT dressing. I’ll share the success and more importantly challenges we have had with the application of NPWT dressing over:
-Sternal wounds: as a temporary wound closure in OR. For an infected Sternal wound (with or without open sternum).
-Open abdominal wound with exposed intestine (with or without fascia closure by mesh)
-Open wounds with fistulae
-Wounds over vascular graft
-Skin grafts over different body parts
Anuradha Godavarty
Florida International University | USA
Title: Automatic segmentation of lower extremity ulcers using near-infrared optical imaging
Biography:
Anuradha Godavarty received a Ph.D. in chemical engineering from Texas A&M University, Texas and worked as a Post-Doctoral Associate in the Department of Computer Science, University of Vermont, Burlington. She started as an Assistant Professor in the Department of Biomedical Engineering at Florida International University, Miami, Florida since 2004. Currently, she is a tenured Associate Professor in the Department of Biomedical Engineering at Florida International University. Her research interests are in developing near infrared optical imaging technologies and applying them for breast cancer imaging, functional brain mapping and wound care monitoring
Abstract:
Lower extremity ulcers are one of the most common complications in diabetes patients. Clinical studies have shown that reduction in wound size of < 40% within 4 weeks is an acceptable progress of the healing process. To date, visual inspection is usually adopted to monitor the wound healing process and wound size is measured from the surface of the images. A Near-InfraRed (NIR) optical imaging approach has been developed to internally inspect the wound by non-contact imaging to differentiate the healing of the non-healing wounds. Herein, an automated image segmentation method was used for the first time to quantitatively measure the wound size from NIR and white light images. NIR wound segmentation was carried out on multiple venous leg ulcers and diabetic foot ulcers (FIU-IRB approved study). Upon applying graph cuts segmentation algorithm, the wound shape demarcated from NIR images closely matches the white light images (but not completely). This revealed that the NIR images are possibly providing tissue oxygenation information from the internal of the wound and not the surface of the wound. Our ongoing efforts are to co-register the white light and NIR images for comparison of the wound demarcated regions and quantification of the wound area
Shanmugasundaram Natesan
US Army Institute of Surgical Research | USA
Title: Regenerative technologies for combat burn injuries
Biography:
Natesan graduated from Central Leather Research Institute, Chennai, India, with the specialization in cell and biomaterials core. He began his professional career as post doctoral research associate at the Department of Extremity Trauma Research and Regenerative Medicine, US Army Institute of Surgical Research, Fort Sam Houston, Texas, US, in the year 2007. He has been actively involved in the stem cell based skin regeneration research. In June 2011 he became a Staff Scientist and presently he is a Research Scientist in the Department of Combat Trauma and Burn Injury Research, continueing his research in developing technologies for treating combat burn injuries.
Abstract:
Burns are a significant problem in combat casualty care. Since 2003, the USAISR burn center has cared for more than 992 military burn casualties and 4500 civilian burn victims. According to the American Burn Association (ABA), approximately 45,000 have burn injuries requiring medical treatment with about 3,500 cases resulting in death. Despite biomaterialadvancements, the treatment of burn injuries by autologous skin graft remains largely the preferred standard-of-care. The major rate limiting step in treating these burn wounds is the regeneration of functional skin layers to avoid further complications and multiple revision surgeries. Some of the currently available artificial skin substitutes try to address this problem, unfortunately, they are less successful in large burn wounds. To address these shortcomings we are investigating the therapeutic benefits of adipose derived mesenchymal stem cells, acellular extracellular matrices and hydrogel based regenerative technolgies to address the clinical shortcomings of current skin substitutes. We envision adipose derived stem cell based tissue engineered skin equivalents will provide beneficial effects to treat severe burn wounds and improve patient outcomes
Abhishek Tiwari
Indraprastha Apollo Hospital| India
Title: Innovations with vac in complex perianal wounds with diversion stoma
Biography:
Abhishek Tiwari has been Graduated from SS Medical College of Rewa, India as Medical Doctor, with the specialties Internal Medicine, PSM, Orthopaedics and ENT. Later on he obtained his post-graduation from KMC Mangalore with subject Gen Surgery including Minimal Access/Robotic Surgery and special interest in wound care and then started working at The Indraprastha Apollo Hospital , New Delhi, where he has continued his research. Presently he is working at the at the New Delhi City
Abstract:
Complex perianal injuries are devastating for patients suffering from them either due to Retropharyngeal Abscess (RTA) or Abscess. Long duration of hospital stay huge cost of management long term antibiotics and analgesics, patient and attendant loss of working days. In short high morbidity and mortality rate in these injuries by conservative management calls for innovation to improve factors discussed above. We managed 6 cases with perianal injuries by diversion stoma and vac dressing along with innovations with advance dressing which otherwise would have taken months to heal or may have scumbed to injuries. Updates and advancement are important aspects of the surgical field and still wound care treated as an orphan son with lesser attention, but it is a morbidity for patient suffering more than any other surgical condition or emergency. Innovations in wound care are need of time and require advancement for better patient care for example in this case perianal injuries
Vijay Langer
Army Hospital (Research and Referral)| India
Title: Coverage of complex limb wounds: the plastic surgeon to the rescue
Biography:
Vijay Langer completed his medical schooling and postdoctoral studies from the prestigious Armed Forces Medical college, Pune, India. He was further a clinical Fellow in Body Contouring following massive weight loss at Iowa City, USA, in 2009. Awarded the Gold Medal in Plastic Surgery by the National Board of Examinations, he is presently Professor and posted to Army Hospital (Research and Referral), New Delhi, which is the largest hospital of the Indian Armed Forces. He has 57 publications including 22 PubMed indexed articles, one chapter in a book, 29 podium presentations in conferences, and is a member of the editorial board of four journals
Abstract:
Limb trauma is a global health concern and indeed is fairly commonly tackled by the military surgeon. While some patients have associated life threatening injuries, a lot of them have isolated but usually complex soft tissue defects. Decision making for managing these patients often requires the aggressive plastic surgeon to step in. From appropriate debridement to arduous but gratifying reconstruction can be planned right at reception of the patient. We in the Indian Armed Forces have taken the initiative to mitigate the suffering of the combatant by this technique and present our 3-year experience of management of such injuries at a large tertiary referral trauma center. 942 consecutive patients with major limb trauma were included in the study. At reception, life saving measures were instituted first followed by limb saving action. Wounds were prepared by debridement during which devitalized tissue was excised. Immobilisation of possible fractures was then done. If there was no exposure of bone, the wounds were resurfaced with autogenous split thickness skin grafts. If bone was exposed, flaps were raised and inset into the defects. If at debridement, it was thought that a second-look was required, then the definitive coverage of the wound was effected then. Lives and limbs were both saved with such timely intervention.
It is indeed a tough challenge to treat patients with major limb trauma. If the patient presents early, the services of the aggressive plastic surgeon are paramount in markedly reducing mortality and significant morbidity in the wounded soldier and the members of his family
Andina Setyawati
Hasanuddin University School of Medicine| Indonesia
Title: Effect of Psidium guajava Lynn on mmp-9 and timp-1 ratio of patients with diabetic ulcer
Biography:
Andina Setyawati has completed his Nursing Master at the age of 26 years from Indonesia University School of Nursing. She is the lecture of medical surgical nursing and wound care clinician. She has published 5 papers in reputed journals and has been serving as an editorial board member of repute
Abstract:
Diabetic ulcer is a main health problem, which was found in 15% of 200 million Diabetes Mellitus patients waorldwide and will increase 2.5% annually. Ulcer can become infection’s port of entry, disrupt peripher blood flow progressively and can cause delayed healing. Hence, it needs innovation on each phase of wound healing, including herbal medicine such as Psidium Guajava Lynn. This study aims to determine the effect of Psidium Guajava Lynn on MMP-9 and TIMP-1 ratio of patients with Diabetic ulcer. This was a quasy experiment study with pre and post-test design with controlled group. Subjects were accidentaly selected in this study. MMP-9 and TIMP-1 was evaluated on first visit and baseline laboratories were taken by Enzyme-Linked Immunosorbent Assay (ELISA). Each subject in the group of intervention took Psydium Guajava Lynn to wash the ulcer each three days. After 10 times, repeat laboratory examinations were taken. No adverse were reported during the trial. The data were analyzed using paired T-test with significance level of a≤ 0.05. This study found a significant on decreasing ratio on intervention group and increasing ratio on control group (p=0,000). This study found significant different of Psidium Guajava Lynn on changing the ratio of MMP-9 and TIMP-1 (p=0,035). This study concludes that Psidium Guajava Lynn could decrease MMP-9 and TIMP-1 ratio for diabetic ulcer patients
Sudha P
Regional Cancer Centre | India
Title: Analysis of the effects of drugs and techniques used in anesthesia on tumor recurrence, metastasis and survival in ovarian serous adenocarcinoma
Time : 17:05-17:30
Biography:
Sudha P is an Associate Professor in Anesthesiology at Regional Cancer Centre, Trivandrum, Kerala, India. She has Post-graduate degree (MD) and Diploma in Anesthesiology (DA), Post-graduate Diploma in Health and Hospital Administration (PGDHHA) and degree of Master of Hospital Administration (MHA) from the University of Kerala, India. Her areas of professional interests are pain management, regional anesthesia, nerve blocks and hospital management. She was awarded UICC: ICRETT Fellowship thrice for doing projects in MD Anderson Cancer Centre, Houston, Texas, Memorial Sloan Kettering Cancer Centre, New York and TJ Samson Community Hospital, Glasgow, Kentucky. She has publications in reputed Indian and international journals
Abstract:
Background: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anesthetic techniques have effects on tumor recurrence.
Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingo-opherectomy from 1995-2008 were analyzed for the effect of anesthetic techniques and drugs on tumor recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors.
Results: The overall survival rate (RR at 95% CI=3.16 (1.79-5.60)) was significantly better in patients who received regional anesthesia for surgery than those who had general anesthesia. Other factors significantly associated with overall survival rate in univariable analysis were, perioperative blood transfusion, preoperative Ca 125 level, FIGO stage, tumor size and lymphatic metastasis. Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate. Recurrence rate did not show significant difference in univariable (Odds 95% CI 1.42 P=0.273) and multivariable (Odds 95% CI=0 P=0.846) analysis. Al1 the 18 patients who had metastasis underwent surgery under GA.
Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anesthesia when compared to those who had surgery under general anesthesia. Prospective randomized control trials are needed for better evaluation.
Biography:
Alex Bekker is Professor and Chairman of Anesthesiology at Rutgers New Jersey Medical School. He obtained his Doctoral Degree in Engineering from the New Jersey Institute of Technology and received his Medical Degree from the Rutgers – New Jersey Medical School. He completed his Anesthesia training at Columbia Presbyterian Medical Center in New York. He has joined the Department of Anesthesiology at the NYU Medical Center in 1995 and was appointed a Vice-Chair for Research in 2005. He is internationally recognized expert in neuroanesthesia and is frequently invited to speak at Grand Rounds and Scientific Panels. He has been active in research for many years. He is an author of 65 peer reviewed publications, 6 US patents, 33 educational reviews and more than 100 abstracts. His work has focused on perioperative brain protection, neuroinflammation, postoperative pain control and clinical pharmacology. He was a PI of numerous clinical trials, including studies sponsored by the National Institute of Aging. He serves on the Editorial Board of the Journal of Neurosurgical Anesthesiology and is ad hoc reviewer for 15 peer-reviewed journals, including NEJM, Anesthesiology, Neurosurgery, PLoS One, and Anesthesia and Analgesia
Abstract:
After attending this presentation, the participants will be able to discuss the incidence, etiology, mechanisms and diagnosis of perioperative stroke; understand preventive strategies which may reduce occurrence of perioperative stroke and identify treatment strategies that are available during perioperative period. Perioperative stroke is defined as an episode of focal or global loss of cerebral function with symptoms lasting more than 24 hours. General surgical procedures are associated with a 0.08-0.7% risk of stroke. Potential stroke etiology includes hypoperfusion, thromboembolism and hemorrhage. The preoperative patient related risk factors for perioperative stroke are: Advanced age, previous cerebrovascular diseases, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation, hypertension, cardiac valvular disease, diabetes mellitus, HTN, atherosclerosis, and renal disease. General anesthesia, dehydration, bed rest, stasis in the postoperative period, and perioperative withholding of antiplatelet or anticoagulation agents can aggravate surgery-induced hypercoagulability and increase the risk of perioperative thrombogenic events. Elective surgery should be delayed for at least 1 month after a documented ischemic stroke. Another consideration in the preoperative period is patients who require chronic anticoagulation. Bridging oral anticoagulant therapy (warfarin) with heparin or low molecular weight heparin should be considered for the majority of patients who require temporary interruption of warfarin therapy. Postoperative risk factors for a stroke include heart failure, myocardial infarction, arrhythmias (atrial fibrillation), dehydration (blood loss) and hyperglycemia. Preoperative administration of statins, ASA, a continuation of anticoagulation therapy (when indicated), as well as appropriate timing of surgery do appear to reduce the incidence of stroke after CABG and vascular surgery and may show similar results in the general surgery population as well