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 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.