Global Wound Care Congress September 12-13 2016
San Antonio, Texas, USA

Biography:

Martina Tierney, an Occupational Therapist since 1983, worked in various settings, including rehabilitation, mental health, nursing and community care. She focused on the provision of specialist seating throughout her career.  As Clinical Director at Seating Matters, Martina oversees the Clinical Team is working on research, education and clinical trials. Through these key areas, she is at the forefront of Seating Matters’ vision; to change the world of healthcare seating. She continually pushes the boundaries of seating innovation whilst improving knowledge available to the healthcare community. Martina has authored ‘The Clinician’s Seating Handbook’, the only handbook in the world dedicated to seating and ‘The Clinician’s Guide to Pressure Injuries’.  Martina delivers Training Days and presents at conferences worldwide, sharing how clinical research improves patient care

Abstract:

While guidance is available on most aspects of pressure injury prevention and management, there has been little information on addressing these issues in seated patients. The issues most often addressed include the use of pressure-redistributing beds and mattresses, risk assessment, repositioning and management of established pressure injury. The role of specialised seating can often be overlooked. This research investigates the effectiveness of a specialised seating programme and its impact on pressure injury incidence in long term care.

Method: A mixed methods, design was ethically approved and employed.  Participants were recruited from three long term care settings before random allocation.  The Control Group continued to use their existing seating while the intervention group was provided with seating tailored to their individual needs following a thorough assessment.  Participants were observed for pressure care, saturated oxygen levels, posture, function and comfort.

Results & Discussion: The significant results proved that no participant in the Intervention Group presented any red skin areas whilst using Seating Matters specialised seating, resulting in an 88.3% reduction in pressure injuries.  In the Control Group, there was a 5% increase in pressure injuries whilst using their existing seating and those with redness noted at the beginning of the trial remained following the 12 week trial period.  Other notable results revealed that oxygen saturation levels increased by 95%, as well as increased functionality and a reduction in sliding or falling from the chair.

Conclusion: This research demonstrates that prescribed seating can contribute to a reduction in pressure injury incidence for patients in long term care. It highlights that the needs of each patient are different, requiring individualised evaluation of seating needs before making recommendations for an appropriate seating system. This research has attempted to address an area which is often overlooked, providing evidence based daytime pressure management through therapeutic seating to compliment therapeutic surfaces at night

Biography:

Michele (Shelly) 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:

Evidence suggests that foot and nail care is the most effective intervention for prevention of wounds and lower extremity amputations most often related to lower extremity arterial and neuropathic disease.  Content in this workshop includes hands on lower extremity skill competency for assessment, intervention, evaluation, follow-up and referral.  A review of comprehensive lower extremity assessment will include loss of protective sensation, poor or lack of blood flow, musculoskeletal deformities and dermatologic conditions.  Opportunity will be given to conduct foot and nail care to include skin care, debridement of nails, appropriate compression therapy and off-loading. The participants will work in teams to conduct hygiene, assessment and intervention.  In conclusion of this workshop a brief discussion will be conducted on necessary follow-up based on assessment data, intervention and referrals needed and appropriate education utilizing adult learning principles

Biography:

Jasmina Begic finished postgraduate study at the Sarajevo University Medical School of Medicine. She is the Medical Consultant for BIOPTRON, Zepter International for Bosnia and Herzegovina, Founder of the Association for Wound management in B&H, Founder and author of Euro-Asian Forum, one of founder of Balkan Wound Management Association. She is member of EWMA Cooperating Organisations Board

Abstract:

Chronic Wounds different etiology are important medical problems and major cause of morbidity in the population. Studies have shown that 5%-8% of the world population suffers from venous disease Etiology of ulcers: 72% venous, 14% venous/arterial, 8% arterial, 6% other. Main etiological factors are venous stasis, tissue hypoxia and blockade of fibrin. Normal blood circulation is very important for not only the strong body, but also the vigorous spirit. Disharmony of blood and Qi resulting in various diseases. Six million days of work lost in the United States because of complications of chronic venous insufficiency in European countries, the treatment cost of venous ulcers has been estimated to range from 1% to 2% of annual health care budget. Modern light therapy includes visible light & part of the infra-red  region which contains a range of wavelengths (480-3400nm) therapy and produces  a biological response PHOTOBIOSTIMULATION. Incident on the skin surface exerts a stimulatory effects on metabolism, circulation, cell regeneration and cell function                             

How does it work?

1.Causes dilatation of blood vessels in the area treated

2. Increased delivery of oxygen

3.Improved local blood flow

4.Increased delivery of nutrients

5.Increased microcirculation and biostimulation

6. Promotion of healing

Increased protein synthesis .

7. Patients didn't have pain.

8. .Faster healing of ulcers

  What is coast benefit ?

1. Complete the heal up.

2. Less infection, eradications in some  case of MRSA

3.Reduce infection, time of hospitalization and length antibiotic therapy

4.Improve Quality of life important, like supplementary or monotherapy in cases that      were resistant to the other therapy and natural noninvasive therapy

5.Lead to healing in cases which were supposed to be treated surgically

6. Holistic effect.

Biography:

Ludwik Fedorko has obtained his Doctoral Degree from Oxford University (UK) in 1983. He then has continued his research at the Hospital for Sick Children (Toronto, Canada) and as a Staff Scientist at the Samuel Lunenfeld Research Institute at the Mt Sinai Hospital (Toronto, Canada). He obtained his Royal College Fellowship certificate in Anesthesiology in 1995.  He continues to practice as Anesthesiologist, Intensive Care and Hyperbaric Medicine attending physician at the Toronto General Hospital of the University Health Network in Toronto. He holds the Associate Professor appointment at the Faculty of Medicine of the University of Toronto

Abstract:

Hyperbaric Oxygen (HBO) has been increasing in popularity as an adjuvant treatment for difficult to heal diabetic wounds. Critical review of literature as well as results of our own work challenge the notion that this is the effective and efficatious treatment modality. A brief review of that evidence will be presented. The most recent clinical guidelines supporting HBO use for diabetic wound are often based on expert opinions and poorly controlled studies with significant biases. A recent, very large dataset retrospective review of prospectively collected multicenter data, with propensity matching methodology, failed to find benefits of HBO for any group of diabetic patientsn with difficult to heal wounds. Similarly, our own prospective double blind, placebo controlled study have failed to show benefit of HBO in any of measured wound healing outcomes, when comprehensive wound care was applied equally in sham and HBO group. HBO is a very time consuming and cost intensive modality requiring daily sessions for six to eight weeks. There are other treatment modalities which were  demonstrated to be effective in a properly controlled clinical studies, at lower costs or/and  patient time involvement. HBO by its very nature and cost may possibly prohibit some patients from obtaining access to several more effective and immediate treatments. We will discuss the rational path to successful healing of difficult diabetic wounds based on the most current scientific evidence

Biography:

Hamilton completed his PhD in Cellular Engineering at the University of Glasgow in 2000. He worked as a Research Scientist with Advanced Medical Solutions PLC., in England, followed by postdoctoral studies at the McGowan Institute for Regenerative Medicine, University of Pittsburgh and at the University of British Columbia, Vancouver. He established his independent laboratory at the University of Western Ontario in 2007, which is focused on biomaterials and connective tissue repair. He has published 39 original research articles and serves as an editorial board member for the Journal of Cell Communication & Signaling and The Journal of Cytology & Histology

Abstract:

Non-healing skin wounds are a major clinical complication associated with aging, diabetes and immobility. Current estimates place the cost of treating these wounds at 2% - 3% of the annual healthcare budgets in developed countries. Many treatments have low clinical efficacy are unpredictable,  all too often resulting in limb amputation. Proper wound management from a clinical perspective involves debridement of the damaged tissue,  as well as prevention of infection. However  to induce healing of the wound, mesenchymal cell recruitment (dermal fibroblasts and perivascular cells) and restoration of blood flow to the wound bed must be achieved. While fibrin and fibronectin normally provide structure to the wound bed during healing, matricellular proteins represent another class of ECM proteins normally upregulated in granulation tissue that modulate the adhesion,  migration, proliferation and differentiation of immune cells, perivascular cells, dermal fibroblasts and keratinocytes. As will be demonstrated, based on their described function, the expected pattern of matricellular protein expression within and surrounding chronic skin wounds is highly abnormal which could be  partially attributable to the combined presence of tumour necrosis factor alpha and transforming growth factor beta. The loss of expression of matricellular proteins including periostin and connective tissue growth factor (CCN2) appears to have significant functional implications for wound healing, as will be discussed. Finally, based on our analysis of human tissue the development of a granulation tissue mimetic scaffold containing periostin and CCN2 will be highlighted, which appears to “force” wounds into the proliferative phase of healing

Biography:

Lauren Flynn completed her Ph.D at the University of Toronto and subsequently started as an Assistant Professor at Queen’s University in 2007 before being recruited to a joint Associate Professorship in Engineering and Medicine at Western in 2014. Dr. Flynn’s research expertise focuses on cell-based regenerative therapies with Adipose-derived Stem/stromal Cells (ASCs) and bioscaffolds derived from the ExtraCellular Matrix (ECM) for applications in soft tissue regeneration and wound healing. In 2013, she co-founded a startup company (Adipologix Inc.) that is focused on the development of her decellularized adipose tissue (DAT) technology for use in plastic and reconstructive surgery.

Abstract:

Over the past 7 years, research in the Flynn lab has been focused on the rational design of novel tissue-derived bioscaffolds for applications in tissue regeneration of the integumentary system. More specifically, our group has pioneered the development of Decellularized Adipose Tissue (DAT) derived from human fat discarded as surgical waste as a platform scaffolding technology for soft tissue regeneration. Adipose tissue represents an abundant and accessible source of both bioactive ExtraCellular Matrix (ECM) components and pro-regenerative cell populations for use in advanced wound healing strategies. Our results have been extremely promising, indicating that the DAT is biocompatible, stimulates angiogenesis and is readily remodeled by infiltrating host cells to promote the regeneration of host soft tissues. Building the DAT as a platform technology, we have subsequently developed methods for fabricating an array of DAT bioscaffold formats including DAT microcarriers and 3-D porous foams, with properties tuned for a range of applications in cell delivery and wound healing. Using these engineered 3-D microenvironments, we have made important progress in understanding cell-cell and cell-ECM interactions in the context of soft tissue regeneration. Our most recent findings further support that DAT scaffolds provide a conducive microenvironment for in vivo soft tissue regeneration and demonstrate that seeding the scaffolds with allogeneic ASCs can help to orchestrate this response by promoting the recruitment of beneficial host cell populations that directly contribute to the formation of healthy host-derived soft tissues

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:

Of the nearly 246 million people diagnosed with diabetes worldwide, an estimated 15% of all patients suffering with diabetes will develop Diabetic Foot Ulcers (DFUs).  About half of these DFUs will become infected resulting in 20% of patients left to face some form of a lower extremity amputation.  To date, clinicians employ visual inspection of the wound site during its standard 4-week of healing process via monitoring of surface granulation.  In many cases, surface granulation is not an implication of internal healing.  There is a need to develop on-site, low-cost imaging tools that can objectively classify healing from non-healing wounds.  Herein, a portable, low-cost, non-invasive, and non-contact based Near-Infrared Optical Scanner (NIROS) was implemented to optical differentiate healing from non-healing Diabetic Foot Ulcers (DFUs).  Non-contact, non-radiative real-time imaging was performed on diabetic subjects with foot/leg ulcers. The near-infrared optical images acquired from the foot were processed to obtain optical contrast ratio between the wound and its background under various conditions of imaging location, selection of wound and background regions and analysis by different researchers (to remove operator variability).  Statistical analysis was carried out to determine the accuracy of the imaging approach to classify healing from non-healing wounds.  Preliminary analysis from diabetic foot ulcers showed an accuracy  >90% in differentiating a wound as healing or non-healing.  The optical classification was based on the differences in the optical contrast between the wound and its peripheries.  Currently, work is carried out to classify wounds based on hemodynamic changes

Biography:

Sowmia Thomas is the orthopaedic clinical nurse specialist at Auckland Hospital, New Zealand. She has completed her Post Graduate studies from University of Auckland and Bachelor of Nursing from Manipal University, India. Her primary role is complex wound care for trauma and also sarcoma surveillance

Abstract:

A 53 year old,  severe spina bifida client was unable to complete a below knee amputation at Auckland hospital in 2015.

The patient was admitted to a critical care unit  with septic shock secondary to bilateral lower limb ulcers, infected with Methycillin Resistant Staphylococcus Aureus (MRSA) and Pseudomonas. Lower limb amputation was the obvious choice of treatment and this was discussed very cautiously with patient and family. The prospect of amputation was calmly but adamantly denied by the patient for over a month, despite extensive discussions with the intensive care specialists, orthopaedic surgeons and family. Multiple cardiac and respiratory arrests while in the critical care unit and lack of consent to proceed with further treatment, prompted a palliative care approach and the patient was moved to the wards.  Surprisingly, the palliative patient decided to undergo the amputation. However, the patient had another cardiac arrest on the operating table and so the leg was amputated, but the wound was unable to be closed.

What made the patient change his decision? Many health professionals encounter stages of grief like shock, denial, anger until the patient consents for an amputation. What did the health professionals miss while they were looking at this patient? What did the patient observe of the hospital system while undergoing complex wound care?  The video also looks at a novel way of closing an amputation wound without any suturing and provides a learning point that even a neolithic procedure like amputation can be ever evolving, in terms of its approach towards the wound and the amputee.

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:

The aim of this initiative is to prepare and mobilize certified foot and nail care nurses to lead research, education and facilitate intervention in an effort to reduce the number of injuries of the lower extremity that lead to amputation/s, morbidity and mortality.  Approximately 45-60% of foot ulcers are related to Loss Of Protective Sensation (LOPS) with another 45% having combined LOPS and Lower Extremity Arterial Disease (LEAD) of people with diabetes.  Approximately 50-80% of all non-traumatic amputations are diabetes-related complications.  The presence of a foot wound is the number one reason for readmission into the hospital for people with diabetes.

Board certified foot care nurses are specialized in hygiene, assessment, intervention to include skin & nail care, education, and referral.  The newly-enacted Medicare programs focus on preventative care and encourage certified foot and nail care nurses’ opportunity to assume a key role in reducing the cost impact of care for people with diabetes, arthritis and Lower Extremity Arterial Disease (LEAD).  A focus on foot care leads to an increase in referrals for therapeutic shoes, use of over-the-counter compression socks and access to care for the older population having difficulty with mobility, sight, and/or cognitive ability. 

Focusing on the feet allows for a comprehensive foot exam annually to establish risk and a determination of frequency thereafter. On-going education is also preventative.  Foot care nurses provide care on a structured schedule and have opportunities to be proactive in prevention with interventions, observations, education and referrals. The importance of repeated and on-going education of patients with potential complications and to remind them to inspect their feet daily ensures that at the first sign of an injury (no matter how minor) it is reported before the injury becomes serious and expensive