Day 2 :
Keynote Forum
Jasmina Begic
Sarajevo University Clinical Center, Bosnia and Herzegovina
Keynote: APPLIANCE OF POLARIZED LIGHT (480-3400NM) IN THE TREATMENT OF CHRONIC WOUND DIFFERENT ETIOLOGY: NEW POSSIBILITIES
Time : 09:15-10:00
Biography:
Jasmina Begic, a Dermatovenerologyst. She finished Graduated and Post-graduated study at Sarajevo University Medical School. Made Project of clinical research about Bioptron polarized light (480-3400nm) in the treatment of Acne vulgaris, Warts and Ulcus cruris (2004). She is Medical Consultant for Bioptron, Zepter International in Bosnia and Herzegovina. Like volunteer in the area of health care founded the Association for Wound Management in B&H (2008), member of EWMA (2009) she organized Euro-Asian Forum (2011, 2012, 2014, and 2016).
Abstract:
Introduction: Application of polarized light (480-3400nm) on cellular and molecular level stimulates chain of biostimulative effects, also stimulating and modulating reparation, regenerative and processes in defense system of organism. Visible part of spectrum of polarized light (480-3400nm) penetrates the skin, reaching papillary blood plexus and affects the circulating blood cells, but also mastocytes, fibroblasts and macrophages within the issue. Normal blood circulation is very important for not only wound healing but also the vigorous spirit. The number of people with wounds and the demand for health services will continue to increase due to changing demographics and an expected rise in the number of people with chronic diseases. Chronic wounds are a major problem to patients and health care systems. A single chronic wound can cost between €6,650 and €10,000 to treat, and it is estimated that around. 1-1.5% of the EU-population has one or more of such wounds. Aim: Aim of this study was to assess influence of polarized light therapy in healing of chronic wounds different etiology and implement integrative medicine, polarized light and tuina massage, in the post-surgery management, treat post-surgery pain, prevent pressure ulcer especially for the patients of third life age after surgical treatments during hospitalization. Method: We treated patients with chronic wounds different etiology. In the topic treatment we used Sodium carboxy methyl cellulose. Primary Wound Dressing with silver (NaCMCAg). This dressing absorbs and interacts with wound exudate to form a soft, hydrophilic gas-permeable gel. The silver ions are released from the NaCMC to exert a sustained antimicrobial effect Appliance polarized light therapy (480-3400 nm) and tuina, like integrative medicine, we stimulated the body homeostatic adjustment mechanism. Results: With this therapy, we had: 1. Accelerated healing time to ulcer closure 2. The decrease of the wound surface area after the treatment was significant, all patients were without pain when we started treatment with polarized light (480-3400nm) 3. Improve the health care 4. Reduce of time and cost of post-surgery treatment. Conclusion: New possibilities in the therapy chronic wounds with polarized light (480-3400nm) and tuina is: 1. Simple 2. Noninvasive therapy 3. With good results in wound healing for shorter period 4. Important in cases that were resistant on other therapy and lead to healing in cases which were supposed to be treated surgically 5.International cooperation 6. Clinical studies and participate in International Clinical research 7. Integration in the Clinical practice, education, scientific research, Academic groups and individuals 8. Integrative Medicine (polarized light and tuina) increases the chances that patients do not experience unnecessary.
Keynote Forum
Sandeep Shrivastava
Datta Meghe Institute Of Medical Sciences, India
Keynote: TRANSLATING WOUND MANAGEMENT
Time : 10:00-10:45
Biography:
Sandeep Shrivastava is from Datta Meghe Institute of Medical Sciences, Wardha, India born in 1968, he took over as DEAN at the age of 42 years. He did his graduation and post-graduation from G. R Medical College, Gwalior, India. He is an Orthopedic Surgeon, with expertise in Limb deformity correction and reconstruction. He have published 2 books, 55 papers, 62 International papers and 6 copyrights /patents on ranging interests from Education to Bio- Informatics. His innovations include a Safety App-Pre-Yell; a research tool - H_COIN; a learning methodology- “Self Assertive Learning”, and an education quality management program-“Academic Appraisal Program”. He is developer for “STARS therapy” for wound healing. He has travelled extensively through all the continents and delivered talk on various aspects of this research project .This is an attempt to fi nd an ideal solution for millions who continue to suffer from complex wounds.
Abstract:
Statement of the Problem: An open injury is associated with loss of skin, exposure of underlying tendons, bones; leading to necrosis and infection. From local applications, antibiotics to medical devices, many intense treatments are in vogue. It takes huge resources in terms of experts, health care setting and fi nances to deal. Th e wound management is a huge challenge. World over billions of US dollars are spent annually on this. It is expected that the recent development of “biologics led therapy” should translate the wound management. In recent times especially aft er 2009, Platelet Rich Plasma (PRP), is been clinically used as an important therapeutic biologic product. Th e purpose of this paper is to evaluate the results pertaining to open wounds treated with PRP including wounds associated with fractures, infections, necrosis and non-healing. An analysis of 125 diff erent wounds is done. Methodology & Th eoretical Orientation: At our center a Biotechnological intervention with PRP is under way. A clinical protocol “STARS therapy” (Sandeep’s Technique for Assisted Regeneration of Skin) has been developed for wound management. It is a “PRP mono-therapy” and does not need any drugs, dressing or surgeries. It’s based on tissue reengineering of wounds and assisted growth of skin by serial PRP infi ltrations. Findings: A complete cure of wound has been established using regenerative medicine product in a standardized manner, including control of infection, tissue regeneration and skin coverage. Th e therapy is developed with intentions to keep it very simple, so that every doctor / nursing personnel can easily impart it. Perhaps for the fi rst time in the clinical care a simple regenerative medicine therapy protocol is developed towards wide applicability, safety, feasibility, easy accessibility and cost eff ectively. Conclusion & Signifi cance: Th is study concludes that this translational clinical research has immense potential for future wound care management in terms of taking out many complexities of current intense wound management.
Keynote Forum
Brigitte Barrois
French PUAP, France
Keynote: PU EPIDEMIOLOGY IN FRANCE
Time : 11:15-12:00
Biography:
Brigitte Barrois is PMR medical Doctor in a French large hospital in Paris area. She works on PU research: Epidemiology and risk assessments. She is consultant for the French PUAP.
Abstract:
PERSE (French national pressure ulcer advisory panel) repeated the national ten year PU (Pressure Ulcer) prevalence survey in 2014. Two previous identical surveys had been organized in 1994 and 2004. Survey methodology has been refi ned in view of new guidelines of scientifi c societies and technological possibilities. Main Aim: Describe PU prevalence of hospitalized patients (acute care, convalescence stay and nursing home) and analyze prevalence evolution. Secondary Aim: Describe PU overall prevalence and for each type of ward, in diff erent French region. Compare results. - Describe PU characteristics (global and adjusted on type of wards and regions). - Identify homogenous groups among patients with PU (cluster method, Ward model) Results: Hospitals taking part in survey were drawn lots all around French country. Th ey receive an invitation to participate: 1075 wards agreed and more than 700 sent back the questionnaires (66%) Questionnaires listed over than 21600 patients hospitalized in acute, convalescence or nursing home wards. Patient’s characteristics are registered with average and standard deviation for quantitative variables and prevalence and numbers for qualitative variables. 1700 Patients had PU that is 8 % prevalence. Previous prevalence was 8.6% in 2004. Patients with PU are older than mean patients. All forms allow patients and PU injury analyses. In intensive care units (192 patients) prevalence seems to decreased (9% against 20% in 1996), a new national survey is conducted in 2017. PU forms enable describing PU types, locations, stages, sizes, constituted. PU are less serious than previously. Risks factors are registered for PU locations according to age, sex, risk level, mean disease and comorbidities. We can see that PU are more serious when risk level is higher.
- Wound and Wound Care |Wound Healing and Tissue Repair | Wound Care and Ulcers| Wound Care and Nursing |Burns and Advanced Wound Care
Location: Richardson
Chair
Thomas E Serena
Serena Groups, USA
Co-Chair
Joel E Michalek
UT health San Antonio, USA
Session Introduction
Thomas E Serena
Serena Groups, USA
Title: ADVANCES IN WOUND HEALING
Time : 12:00-13:00
Biography:
Thomas E Serena, Founder and Medical Director of SerenaGroup®, a family of wound, hyperbaric and research companies. Serena completed his residency in Surgery at the Hershey Medical Center. To date he has opened and operates wound care centers across the United Sates and globally. He has been the lead or Principal investigator in over 100 clinical trials and is recognized internationally as an expert in the fi eld of wound healing: He has more than 100 published papers and has given more than 1000 invited lectures throughout the world. He has been a member of the Board of Directors of the Wound Healing Society and served two terms on the board of the Association for the Advancement of Wound Care (AAWC) and is now the President-Elect. He has also been Vice-President of the American College of Hyperbaric Medicine and President of the American Professional Wound Care Association.
Abstract:
The science of wound healing strives to meet the ever-expanding numbers of patients suffering from chronic wounds. Problem wounds have eclipsed cancer as the most dreaded malady with greater morbidity and mortality and far greater numbers of victims. This lecture addresses advances in the field that have improved diagnosis, enabled better delivery of care and permitted the analysis of large amounts of data. These developments improve the quality of life for our patients. If total Contact casting is the gold standard for off-aoding the diabetic foot, why haven’t physicians incorporated TCC into their practices? We struggled with this question for years. We discovered several factors that contributed to this phenomenon: unfamiliarity with cast saws, the weight of the cast, the strength of the cast and drying time. In this workshop, we will demonstrate a novel TCC that solves all of these problems.
Biography:
Dev completed his undergraduate studies at Texas Tech University and Cal State University, Long Beach. He studied Medical Ethics at Oxford and Biomedical Sciences at UCSD, and earned his M.D. degree at Ross University in New Jersey. Dev is an assistant clinical professor at the Aesthetic Plastic Surgery Institute at the University of California, Irvine. Dev has enjoyed a distinguished academic career and has authored or co-authored greater than thirty publications in General Surgery, Reconstructive and Plastic Surgery, and aesthetic techniques. Dev has provided medical expertise to a number of our armed forces men and women who have returned from Iraq with serious injuries. Dev is Chairman and Chief Executive Offi cer of Health Universe (HLUN). Dev is the Wound Center Medical Director of Memorial Hospital in Bakersfi eld, CA, and Chief Medical Offi cer for ManukaMed USA. He is the Medical Director of Physicians Care of California, and Dev serves as the Research Director of the Mesotherapy Institute of Technology. He joins. Jordan and Jennings as Clinical Instructors of MIT’s mini-Fellowship training program.
Abstract:
This is a retrospective study of 2,252 chronic wounds in four rehab and skilled nursing facilities comparing wound healing rates for nine diff erent wound care products over a 10 year period. Th e data clearly demonstrates superior healing rates for Manuka Pli when compared with other products such as Santyl, silver products, other manuka honey products, and vac therapy among others. Th e study also indicates superior debriding capabilities of Manuka pli when compared with santyl and other debriding agents as measured by improved wound surface area aft er 15 treatments. With concerns about biofi lm formation and reduction to assist wound healing it should also be noted that Manuka Pli when compared to silver dressings shows impressive antimicrobial activity. Given the superior outcomes and the lower expense of Manuka Pli, this product should be the preferred wound care product from beginning to end in the treatment of chronic wounds in rehab and skilled nursing facilities.
Jinsong Hao
Marshall University, USA
Title: CARDIOTONIC STEROIDS AND WOUND HEALING
Time : 14:30-15:00
Biography:
Jinsong Hao is currently an associate professor in the School of Pharmacy at Marshall University. She obtained her Bachelor of Engineering degree in Pharmaceutics and Ph.D. in Pharmaceutics from Shenyang Pharmaceutical University, Liaoning Province, PR China. Upon her graduation, she started her academic career at the same university as an assistant professor and associate professor. Prior to her joining the Marshall University in 2013, she worked at the National University of Singapore, Nova Southeastern University, and University of Cincinnati. Hao’s research has been in the area of drug formulation and delivery, with experience in transdermal and topical formulations; drug delivery to the nail, eye, and inner ear; siRNA delivery; and pharmacokinetic study. She has over 50 publications in peer-reviewed journals and published several book chapters.
Abstract:
Statement of the Problem: Chronic wound healing has been a clinical challenge. Th ere is an urgent need to develop novel wound healing therapeutics. Cardiotonic steroids (CTS) have been used for the treatment of cardiac diseases and their mechanisms of action are associated with Na/K-ATPase. It was reported that the binding of CTS with the Na/K-ATPase resulted in increased collagen synthesis by dermal fi broblasts. Th e objective of this study was to determine the wound healing eff ect of a model cardiotonic steroid in a wound model. Methodology: Full-thickness wounds were created in rats by a biopsy punch. Th e vehicle alone or a testing CTS solution was applied to the wounds. Findings: Increased collagen synthesis by dermal fi broblasts aft er exposure to the CTS was observed. Th e wound closure rate was signifi cantly increased following the treatment with the CTS. Conclusion & Signifi cance: Th e CTS primarily elicited a wound healing eff ect in the proliferation phase and might be a potential wound healing therapeutics.
Zhi Ren Liu
Georgia State University, USA
Title: EXTRACELLULAR PKM2 FACILITATES WOUND HEALING BY PROMOTING MYOFIBROBLAST DIFFERENTIATION
Time : 15:00-15:30
Biography:
Zhi-Ren Liu is a Professor in Department of Biology, Georgia State University, Atlanta, USA. He completed his Ph.D in Biochemistry from Florida State University in 1994. The goal of our research is to understand the molecular mechanism of cell abnormality, especially the conditions that are associated with many human diseases. We hope that our understanding will ultimately be converted to the development of new diagnostic and therapeutic strategies. Currently, we are focus on following two separate research projects: Function of p68 RNA helicase in cell developmental program and tumor progression. His research area of interest is Molecular Biology & Cancer Biology.
Abstract:
Injury induced tissue regeneration oft en starts with infl ammation responses. Th e infi ltrated neutrophils and/or macrophages release various diff erent cytokines and growth factors that promotes myofi broblast diff erentiation. Myofi broblast plays a key role in tissue regeneration and reconstruction. However, sustained myofi broblast diff erentiation and survival lead to fi brosis. We report here that infi ltration neutrophils at the wound site release PKM2, a glycolytic enzyme, by its secretive mechanisms during early stages of regeneration. Th e extracellular PKM2 facilitates wound healing by promoting early granulation and angiogenesis. PKM2 facilitates formation of early granulates by promoting fi broblast migration and myofi broblast diff erentiation. Extracellular PKM2 also protects myofubroblasts from apoptosis. We demonstrated that extracellular PKM2 promotes myofi broblast diff erentiation by a TGFβ independent pathway via activation of integrin ï¡vβ3 signaling. Our studies uncovered a novel mechansim of integrin activation. Extracellular PKM2 activates integrin ï¡vβ3 by binding to head open integrin and facilitating a “leg” separation conformation. Our studies reveal a new molecular linker between the early infl ammation response and proliferation phase in tissue regeneration process. Our studies also uncover a novel mechanism of promoting myofi broblast diff erentiation.
Louis Filhour
Albany Medical Center, USA
Title: THE LIVED EXPERIENCE OF SUFFERING OF MALES AFTER BLUNT TRAUMA: A PHENOMENOLOGICAL STUDY
Time : 15:30-16:00
Biography:
Louis Filhour has held executive positions as CNO and COO for more than 20 years. Although he is now the CEO for a system of hospitals and providers trying to transform care for the Medicaid population, he is also contributing to the science supporting the practice of professional nursing through his research. Working at a busy Level 1 trauma peaked his interest in the experience of suffering. He holds nursing degrees from Baylor University, Boston College, and the University of Phoenix.
Abstract:
Suff ering is a subjective human experience that is both complex and unique. Although relieving suff ering is a goal for nursing, the phenomenon of suff ering is poorly understood and even goes unrecognized. Using a phenomenological design, the researcher explored the question of what is the experience of suff ering as voiced by male patients seven to twelve months aft er hospitalization for blunt trauma. Seventeen male volunteers were interviewed and asked questions about how they suff ered, what made their suff ering more or less bearable, and how they were transformed through their suff ering. Participants experienced changes in patterns resulting in a perception of suff ering. Participants reported mostly experiencing physical, emotional, and social forms of suff ering while fewer experienced economic and spiritual suff ering. Experiences of suff ering resulted from the threat to their normal state or sense of wholeness because of their injuries. Intrinsic and extrinsic factors were identifi ed making the participants’ suff ering more or less bearable as they regained their lost state of normal. Positive attitude and motivation were signifi cant intrinsic factors while quality supportive care was the most signifi cant extrinsic factor. Poor quality care was a signifi cant negative extrinsic factor resulting in experiences of increased suff ering. Th rough their experiences of suff ering the participants were transformed, amending their previous state of normal. Knowledge gained through this phenomenological study may be useful to nurses in guiding their care to alleviate patients’ suff ering.
Claudia F Benjamim
Federal University of Rio de Janeiro, Brazil
Title: ADP TREATMENT IMPROVES WOUND HEALING IN DIABETIC MICE
Time : 16:30-17:00
Biography:
Claudia Farias Benjamim has completed her MD in the Unit Basel University Hospital and she has worked as General Practitioner in occupational Disorders Ali Abaad Industrial Area, Garmsaar, three postdoctoral studies: 1999-2001 in the Pharmacology Department, Sao Paulo University; 2001-2004 in the Pathology Department, University of Michigan, MI, USA; and 2012-2013 in Myology Institute, University Pierre et Marie Curie, Paris, France. She is an associate professor/ researcher in Federal University of Rio de Janeiro, RJ, Brazil. She has published 45 papers in reputed journals and has been serving as an editorial board member of repute. Benjamim aims to understand cellular response in chronic infl ammatory disease as sepsis, pulmonary fi brosis and skin wound healing. Her group studies the pathophysiology of these diseases and searches for successful therapies. Her group expertise is cell and molecular biology.
Abstract:
Statement of the problem: Chronic wound is a public health problem worldwide, which aff ects 6.5 million patients in USA. Such problem, in association with high global prevalence of diabetes, refl ects the increase in diabetic ulcers. Considering the absence of an eff ective treatment for chronic wound, the purpose of this study is to investigate the possible benefi cial eff ects of a purinergic agonist in tissue repair of chronic wounds in diabetic mice. Methodology: Diabetics was induced by Aloxan (75 mg/Kg I.V). Seven days later mice were anesthetized and a full-thickness wound was induced surgically using a punch biopsy (1 cm of diameter). ADP (30 μM) was topically applied once a day for 5 days consecutively on the wound. Findings: We observed that ADP accelerated the wound contraction, improved tissue repair, increased collagen deposition and recruited neutrophils and eosinophils to the wound. Also, ADP increased the number of mast cells and myofi broblasts in the wound. Besides, ADP positively modulated its own receptors, VEGF and TGF-α in the wound. Th ese eff ects were only observed in diabetic mice. More interestingly, others nucleotides did not accelerate the wound healing as ADP. Clopidogrel treatment, a P2Y12 receptor antagonist, prevented all parameters evaluated, confi rming the role of the P2Y12 in ADP eff ects. Still, ADP seemed to increase the number of arginase+ cells and to reduce iNOS+ cells, which implies in the increase of M2 macrophages in the wound. In in vitro experiments, ADP increased fi broblasts proliferation and migration, which corroborate with the in vivo studies. Finally, ADP also accelarated the S. aureus-infected wound healing. Conclusion & Signifi cance: ADP seems to modulate cell activation and recruitment providing an adequate scenario for wound healing in diabetic mice, being. It seems to be a promising treatment for chronic wounds.
Saman Mohammadipour
Treata hospital, Iran
Title: NEGATIVE PRESSURE WOUND THERAPY FOR INFECTED SURGICAL SITE AND MESH EXPOSURE WITH SILVER BASE FOAM
Time : 17:00-17:30
Biography:
Saman Mohammadipour is a colorectal surgeon with a decade experience in wound management, using silver combined with all methods is one of his favorites. Vacuum therapy is one of best method to manage big wound combination with silver base gauze or foam, following his last article in wound therapy. He presents this article as a method for managing surgical site infection with mesh.
Abstract:
Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. Th e use of synthetic prosthetic mesh is well established as the surgical treatment of choice for repair of ventral incisional hernias. Use of these mesh materials may result in specifi c complications that range from minor to potentially life-threatening. Th e defi nitive treatment for any infected prosthetic material in the body is removal and substitution. Sometimes you can manage the infected wound without removal the mesh with open abdomen dressing and irrigation and control the infection with parallel antibiotic therapy. NPWT has been demonstrated to signifi cantly improve patient survival and facilitate earlier closure of the open abdomen. In this study we used npwt for management of open abdomen with infected mesh with silver-based foam. Th is article reviews the case of 64 year-old man with infected surgical wound and mesh with history of surgery due to big abdominal hernia and gastrointestinal fi stula. Aft er several irrigations, the wound was dressed by negative pressure wound therapy with silver-based foam without removal the mesh. Th e wound improved without any further surgery. We found that negative pressure wound therapy with silver-based foam could be used on infected prosthetic mesh in wound besides control of infection without further surgery for mesh removal.
- Wound Care and Ulcers | Wound Care and Treatment | Wound Care and Regenerative Medicine | Wound and Pain Management| Wound Care and Diabetes| Wound Care and Infection Control
Location: Richardson
Chair
Jasmina Begic
Sarajevo University Clinical Center| Bosnia and Herzegovina
Co-Chair
Brigitte Barrois
French PUAP | France
Session Introduction
Maria Shaw
Palmerston North Hospital, New Zealand
Title: FOOT ULCERS: A DIFFERENT TECHNIQUE TO TOTAL CONTACT CASTING FOR HEALING CHRONIC FOOT ULCERS
Time : 12:00-12:30
Biography:
Maria Shaw has her expertise in Orthopedics and a passion in Wound Care providing the best possible outcomes for patients. She runs her own Nurse Lead clinics where she sees up to 14 post-operative patients per day, including trauma patients from ED. Her cast care skills introduced her to a new idea for offl oading chronic ulcers. The outcome has been very promising resulting in ulcers healing in signifi cant reduced time frame; therefore, reducing the work load on the plaster room staff who are not required to do total contact casting. However, some ulcers are not suitable for this management due to ongoing co-morbidities. Further research is required to accommodate these patients.
Abstract:
Statement of the Problem: Chronic foot ulcers are growing concern worldwide, in particular diabetic foot ulcers. Th e combination of neuropathy and exudate, causing maceration, inhibits eff ective healing. Previously, a total contact cast would be used to off load patients with chronic foot ulcers, a window would be cut into the cast to access the wound for dressing change. However, when heavy exudate is present the dressings and the cast need to be replaced. Ulcers improve with this method but usually take over a year or more to heal. Th e numerous dressing, and cast changes has a substantial cost to the DHBs and a signifi cant impact on a patient’s quality of life. Methodology & Th eoretical: As with most chronic ulcers, there is a degree of neuropathy keeping the feet cold and with limited feeling. Changing from using synthetic casting, to a Soft offl oading bandage (SLb), has seen a marked reduction in healing times for these ulcers. SLb included plaster stocking, soft ban, crepe bandages, and a Moonboot or DARCO shoe. Th is kept the foot warm and offl oaded at the same time. Th ere were a total of seven chronic ulcers seen within a year and fi ve out of the seven ulcers healed within three to six months. Th e 6th was healing well but due to unstable co-morbidities, the client was removed from the study. Th e 7th client had chronic osteomyelitis, and was also removed from the study. Conclusion: By simply altering the off -loading technique and keeping the foot warm resulted in faster healing rates for chronic ulcers. Although not suitable for all patients, there was a signifi cant reduction in the time frame for healing ulcers; this had a positive impact on the patient’s quality of life and a marked reduction in costs to the DHB.
Judith A Barnard
Northern Lincolnshire and Goole NHS Foundation Trust, England
Title: THE DESIGN AND IMPLEMENTATION OF A LOCAL STRATEGY TO INCREASE THE ACCURACY OF PRESSURE ULCER CLASSIFICATION: THE PRESSURE ULCER GUIDANCE (PUG) TOO
Time : 12:30-13:00
Biography:
Judith Barnard is a Registered Nurse and has been a Tissue Viability Clinical Nurse Specialist for about three and a half years. She has a passion to reduce the incidence of hospital acquired pressure ulcers Misclassifi cation was proving to be problematic she is working to help healthcare professionals overcome this problem. The idea for the PUG wheel came when a need for a more accessible tool for nurses would make it easier to assess patient’s pressure areas. By using a different perspective healthcare professionals are able to correctly stage skin damage.
Abstract:
Statement of the problem: Approximately 120 pressure ulcer referrals a month are reported requiring verifi cation. It was apparent that the skills of the staff assessing these patients was problematic, their classifi cation of a pressure ulcer and identifying what type of ulcer they were looking at was unreliable. Many of the nursing staff within the trust was unable to distinguish between various pressure ulcer stages and diff erentiating superfi cial pressure ulcers from moisture lesions, this oft en lead to inaccurate reporting and inappropriate management. Intervention and methodology: Utilizing the European Pressure Ulcer classifi cation guidance 2014 an easy to use image illustrated decision making tool was designed. Th e laminated double sided wheel refers to pressure ulcers on one side and side two refers to moisture lesions, suspected deep tissue and unstageable. A logo used on the tool was developed from the Pressure Ulcer Guide, which includes PUG; the Pug dog has now become an insignia. Th e tool was shared with the Tissue Viability Link nurses. Measurements of results: Preliminary testing with 20 link nurses on 20 verifi ed pressure ulcer and moisture lesion images resulted in an 80% accuracy rate without the tool to 100% accuracy rate when using the tool. In the months from October – December 2015 an estimated 73% of pressure ulcers were miss-classifi ed, since the introduction of the PUG tool a recent audit estimated 80% of skin damage is now being classifi ed correctly. Conclusion: In this short period of time the classifi cation skills among healthcare professional have improved resulting in more accurate reporting. Th is strategy will help provide a consistent approach to clinical practice complementing patient assessment and care planning. Pressure ulcers that are assessed and classifi ed correctly can be appropriately managed and may lead to faster healing improving the patient’s quality of life and ultimately lead to a reduction in associated costs.
Akobi Oliver Adiyemi
Federal Medical Centre, Nigeria
Title: BACTERIOLOGICAL PROFILE OF WOUND SEPSIS AND ANTIMICROBIAL PATTERN OF ISOLATES AT FEDERAL MEDICAL CENTRE, BIDA, NIGER STATE
Time : 14:00-14:30
Biography:
Akobi Oliver Adeyemi is Assistant Chief Medical Microbiology, practicing on the bench, and working with Federal Medical Centre, Bida, Niger State, Nigeria. Oliver currently doing his PhD in Medical Microbiology at Igbinedion University, Edo State, Nigeria, and working on Antimicrobial Resistance in Clinical Isolates. Oliver has taking part in the training of intern Medical Laboratory Scientist since September, 2010. He collaborated with other professional colleagues to publish several publications in international journals.
Abstract:
Aim: The study was aimed to identify etiology of bacteria associated with wound sepsis and antimicrobial susceptibility profi le of the isolated organisms in the community. Study Design: It is a retrospective study; data were obtained from Medical Microbiology department register from May 2005 through October 2007 and was exempted from ethical approval. Swab samples were collected from 408 patients between age groups 0 through 75years. In and out patients with various injuries such as burns, post-surgical wound, fracture and ulcer wounds. Samples were culture within 1hour on MacConkey agar, blood agar and chocolate agar, and incubated at 37o c 18-24 hours overnight. Data were coded and computed using SPSS 16.0 and p-value 0.05 was considered statistical signifi cant. Results: Out of 338 (82.8%) positive culture, overall highest isolates was found within age groups 31-40years with 69(94.5%) growth followed by 21-30years 61(85.9%) and statistically not signifi cant ( p-value 0.814, mean age =11.34, median =12.00 and S.D±4.361).Th e highest single colony isolates was Staphylococcus aureus 122(42.5%) followed by Escherichia coli 108(37.6%) and Pseudomonas aeruginosa 28(9.8%). Staphylococcus aureus the highest single colony was susceptible to Ceft riazone 75(61.5%), Ciprofl oxacin 71(58.2%) and Clindamycin 83(68.0%). Conclusion: Th e incidence rate of wound sepsis in the studied population is 338(82.88%) and incriminating single colony isolate was Staphylococcus aureus 122(42.5%). Stake holders need to educate patients visiting hospital community on the danger of wound sepsis and fi rst aid treatment before visiting tertiary health care to reduce morbidity and mortality rate.
Igal Kushnir
RedDress Ltd, Israel
Title: A PROSPECTIVE, OPEN-LABEL, UNCONTROLLED STUDY EVALUATED THE CLINICAL PERFORMANCE OF RD1 IN CHRONIC DIABETIC FOOT ULCERS AT THREE WOUND CARE CLINICS IN THE USA
Time : 14:30-15:00
Biography:
Igal Kushnir, Founder, RedDress Ltd: Holder of other medical device patents; invented a device in body thermoregulation for MTRE Advanced Technologies of which he was the founder and CEO for 5 years; invented a non-invasive functional imaging device of body organs such as the lungs and heart for Deep Breeze Ltd. of which he was the founder and CEO for 7 years; Lead the closure of a strategic contract with GE Healthcare and brought the company to full commercialization; vast experience as a family physician specializing in Pediatrics; has had a private clinical practice for the past 30 years; for 10 years held the position of chief physician and medical manager for a hospital for chronically ill patients; graduated cum laude from Tel Aviv University (Israel) and holds a Medical Degree specializing in Pediatrics.
Abstract:
Statement of the Problem: Chronic wounds stall in the infl ammatory phase of wound healing characterized by the presence of non-viable tissue, excessive bacterial burden, and the presence of increased infl ammatory cytokines. Th e RedDress Wound Care System (RD1; RedDress Ltd, Israel), is an autologous, biodegradable fi brin scaff old that recreates the functional wound healing environment with minimal risk of immunorejection. Th e primary objective of this study was to determine safety and effi cacy of the RD1 in the treatment of diabetic foot ulcers (DFU). Methodology & Th eoretical Orientation: Following a screening period of 2 weeks, wounds were treated weekly for up to 12 weeks with the RD1. 20 subjects with 20 DFUs were enrolled at 3 sites in the USA. Two subjects were not compliant with the protocol, resulting in 20 subjects for the ITT (intent-to-treat) analysis and 18 for the PP (per protocol) analysis. Findings: Safety: Th e mean AE rate for both ITT and PP populations was 1.6. Effi cacy: Th e proportion of wounds completely healed in the ITT and PP populations was 13/20 (65%) and 13/18 (72%), respectively. Th ere were 4 occurrences of ulcer recurrence following initial healing, with 2 occurrences resulting in unhealed wounds (same for ITT and PP). Percentage area reduction (PAR) for the ITT population at 4 and 12 weeks was 61.3% and 66.6%, respectively; the fi gures for the PP population were comparable at 4 weeks but better at 12 weeks: 60.0%, and 76.1%, respectively. Mean time to heal in the ITT population was 59 days and 56 days in the PP population. Conclusion & Signifi cance: Th e study demonstrated the safety and effi cacy of the RD1 in treating DFUs and the use of a natural autologous blood clot as a mean to support healing in DFUs.
Efraim Jaul
Hebrew University of Jerusalem, Israel
Title: COMMON PATHOPHYSIOLOGICAL MECHANISMS UNDERLYING DEMENTIA AND PRESSURE ULCERS
Time : 15:00-15:30
Biography:
Efraim Jaul is a specialist in Family Medicine and Geriatric Medicine, Clinical Senior Lecturer in the Hebrew University of Jerusalem, Faculty of Medicine-Jerusalem. Since 1991 served as Head Department of Geriatric Skilled Nursing department, Sarah Herzog Medical Center Jerusalem, Israel affi liated with Medical Faculty, Jerusalem. Published 44 scientifi c papers in national and international journals and fi ve books on aging. Main interest is assisting the frail elderly confronted with Pressure Ulcers. In 2002, developed and established a pioneering inpatient unit at the Herzog Hospital specifi cally for the treatment of pressure ulcers. The vision for this approach in a published article entitled "Setting up a Dedicated Pressure Ulcer Unit", (Journal of Wound Care, 2003), concerning the need for a special unit specialized system and the resulting benefi ts for the immobile patients. This unit has elicited interest with concerns for patients with advanced dementia, chronic diseases and vegetative state. Currently, investigate comorbidities focusing on advanced dementia and pressure ulcers in an effort to understand the underlying pathogenesis.
Abstract:
Increased longevity, especially in frail elderly patients, there is a higher rate of dementia resulting in functional and cognitive impairment leading to disabilities, immobility and Pressure Ulcers (PU), representing a fi nal pathological pathway. Our research goal was to elucidate common pathophysiological mechanisms underlying dementia and PU. Apparently, it looks as these are two separate conditions. Dementia is typically viewed as a neurodegenerative disease without peripheral implications. Pressure ulcers are manifested as a local skin problem particularly in frail, immobile elderly patient. Finding common etiological paths between pressure ulcers and dementia will produce new treatment strategies that could lead to the prevention of pressure ulcers, sensitized clinician awareness to PU in mild to moderate dementia could lead to the suppression of PU onset, ultimately decreasing suff ering during the advanced stages of dementia. Studies consistently demonstrate a signifi cant association between various comorbidities especially dementia and pressure ulcers in frail elderly patients. Th e precise physiological mechanisms that lead to dementia and pressure ulcers comorbidity versus other comorbidities are not clear. Th e potential hypothesized pathophysiological mechanism causing "peripheral" impact of dementia, particular in Alzheimer disease, is related to changes in fi broblast aggregation rates in the skin tissue, in conjunction with continuous deterioration of the neurophysiological subsystems associated with: motor, sensory, autonomic, cognitive, and behavioral pathways linking pressure ulcers with dementia progression.
Brigitte Barrois
French PUAP, France
Title: PERSE: FRENCH PUAP, IMPACT OF 25 YEARS HISTORY
Time : 15:00-16:00
Biography:
Brigitte Barrois is PMR medical Doctor in a French large hospital in Paris area. She works on PU research: epidemiology and risk assessments. She is consultant for the French PUAP.
Abstract:
PERSE (French national pressure ulcer advisory panel) was created in 1991. Missions are prevention, education and research about PU (Pressure Ulcers). 25 years history results are registered on assessments: epidemiology is the one of the bests. PERSE Constitution: Professional group with medical doctors, nurses, physical therapists, pharmacists and researchers. PERSE Field of Interest: Assessment and care, patients typology (geriatrics, spinal cord injured, infants), pressure ulcers (risk factors, stage, locations, etiology), aging process, nutrition, wound healing, germs, pain, dressings, treatments, innovation, costs and public healthcare education. PERSE Results: National Guidelines in accordance with international guidelines: PU prevention and treatment for adults and elderly in 2001 updated in 2012, Medical and surgical care for PU in neurologic diseases in 2016. Research: Fundamental on microcirculation, clinical microbiology, epidemiology (national in hospitalized, elderly, intensive care, at home), applied with companies researchers. Education Development: National meeting conferences, annual educational conference, journal and university degrees. PERSE Actions Impact: Epidemiological research results = prevalence and PU severity decrease in France. We can check this impact in Gonesse French hospital were a multi professional PU group has been working on education and assessment since 25 years and where prevalence is under national level : i.e. 6.8% PERSE Objectives for Next 25 Years: Improve at risk patients tracking to improve right care to right patient and to reduce PU.