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Featured Articles

  • November 20, 2018

    A Case of a Patient with Severe Epidermolysis Bullosa Surviving to Adulthood

    Epidermolysis bullosa (EB) is a group of rare inherited connective tissue diseases that result in blister formation on the skin. The incidence rate is 20 per million births in the United States. It occurs in all ethnic groups. The lesions, which can initially appear after birth or anytime until early adulthood, often present as dense blisters that may eventually rupture and lead to scars. Blisters usually occur at the sites of trauma or pressure, which are primarily the hands, feet, and diaper area in children, but may also present in the mouth, gastrointestinal tract, or genitalia. Generally, EB is a chronic condition that is disfiguring and painful. Patients with EB may have co-occurring conditions such as fused digits and clubbed hands or feet. Read More

    Stem-Cell-Laden Skin Grafts Could Heal Burn Victims 30% Faster, if Not Quicker

    Researchers at the University of Toronto (UoT) are working to give burn victims their skin back. The team has developed a new process by which stem cells are retrieved from the burned skin and used to speed up recovery. Such a treatment option would greatly improve the chances of survival for those involved in fires or industrial accidents, as well as their quality of life to boot. The team plans to start human trials by early 2019. Read More

    Classifying Diabetic Foot Ulcers

    While dermatologists are unlikely to treat patients with severe foot infections that require hospitalization, they must be able to diagnose and manage mild-to-moderate infections in diabetic foot ulcers (DFUs), and follow current Infectious Diseases Society of America (IDSA) guidelines regarding antibiotic use, according to Warren S. Joseph, D.P.M., FIDSA, who presented at DERMfoot 2018. He is a consultant, lower extremity infectious diseases, Roxborough Memorial Hospital, Philadelphia, and a co-author of the IDSA guidelines, which appeared in Clinical Infectious Diseases in June 2012.   Read More

    The Power of Continuous Monitoring to Transform Post-Acute Care

    As an administrator in a skilled nursing facility, I see firsthand and recognize the hard work that clinicians and professional staff that work in this type of environment must endure. Often, I bare witness to these unsung heroes of healthcare, working long hours with strenuous workloads, while trying to provide the best possible care for the patients and residents in their facilities. As we all recognize, in today’s environment, many of our clinicians and caregivers are being asked to do even more, facing additional challenges by caring for more medically complex patients who historically have been cared for in hospitals. Many of these patients have multiple chronic conditions and require more comprehensive care. Read More

  • November 13, 2018

    Hospitals Report Fewer Bedsores, But Does the Math Check Out?

    The prevention and management of hospital-acquired pressure ulcers, or HAPUs, varies greatly, according to new research. Ask any patient who has ever had one: a bedsore hurts a lot. And if it doesn’t heal, that sore can last for years, eating away at the flesh and leading to infections, sepsis, or even death. That’s why hospitals have worked for years to reduce the chance that patients will develop such sores—also called pressure ulcers or pressure injuries—and to treat new ones quickly. It’s also why Medicare pays less to hospitals with the highest hospital-acquired complication scores, which include HAPUs. But a new study shows important differences between two sources of data used to track the rates and progress of HAPUs. The hospital billing data used to calculate Medicare payment rates and penalties for hospitals may miss many of the HAPUs that patients are actually getting, the study finds. And hospitals’ progress in reducing HAPUs is almost entirely because they prevented less-costly and less dangerous early-stage HAPUs, and not the more severe kind, according to billing data. Read More

    At 88, San Antonio’s ‘Father of Burn Care’ Isn’t Stopping

    Dr. Basil Pruitt returned to San Antonio from Vietnam as commander and director of the U.S. Army Institute of Surgical Research, (the Burn Center) at Brooke Army Medical Center, a position he held for 27 years. When Dr. Basil Pruitt became commander of the U.S. Army Institute of Surgical Research at Fort Sam Houston in 1968, he began a tradition that fellow physicians, nurses and laboratory researchers came to dread — Saturday “grand rounds.” Pruitt went patient to patient at Brooke Army Medical Center with a team that included laboratory section chiefs — pathology, bacteriology, hematology and others. Until Pruitt ran ISR’s burn center, the visits were on weekdays. Lab chiefs were not involved. “When I retired, the next Saturday there were no grand rounds,” he laughed. Pruitt, 88, is considered the father of burn medicine because of the advances he helped pioneer. One of his most important contributions at the ISR, where he spent 27 years, was to discover why burn wounds get infected. He teamed up with the late Arthur D. Mason Jr., chief of the laboratory division, who developed and tested a burn cream on animals. Their work led to a reduction in patient mortality and other important clinical-laboratory collaborations. Read More

    Philly’s Best and Worst Nursing Homes, According to Government Data

    The addition of new quality measures for nursing homes receiving federal funds could soon upset the pecking order of Philadelphia’s best — and worst — nursing homes, according to the latest government data. Roughly once every quarter, the federal government updates its quality rankings for nursing homes that receive funds from Medicare and Medicaid. Each facility receives an overall star rating — from one to five — based on its most recent health inspections, staff-to-patient ratios, and quality of care. But this month, the results included something new — stats tracking pressure ulcers, patient-treatment plans, and fall-related injuries. The new measures could offer key insights into the quality of staff responsiveness and care, said David Hoffman, president of a national health care consulting firm based in Philadelphia. “I think staffing is the most important issue in long-term care,” Hoffman said. “And it’s not just numbers — it’s competence.”  Read More

    Changing the Narrative Around Light Compression

    Compression therapy is a clinical intervention and high compression therapy produces better healing rates than no compression;4 compression therapy delivers results when a high sub-bandage pressure is delivered to the limb accompanied by a high static stiffness index.5 Unfortunately, despite nearly 30 years of education, there remains a lack of understanding about the role of this important therapeutic intervention and the art required in enabling patients to tolerate the regime. To the untrained ear, reduced or light compression sounds friendly—a kind response to a challenging situation. What would happen if we changed our language and called these reduced regimes weak, ineffectual or sub-optimal? A change in terminology may make all of us wake up to what is happening, and the subsequent harm to patients’ lives. Read More

  • November 7, 2018

    Efforts to Prevent Pressure Ulcers in Hospitals May Not be Making Headway on the Worst Kind

    In a new paper in the November issue of Health Affairs, the research team from the University of Michigan recommends better ways of tracking HAPUs for value-based purchasing policies. The program should use the same approach hospitals already use to track infections that patients develop during their stay, and adjust rates and penalties based on patients' underlying risk. Better data will mean more valid penalties for HAPUs, which affect 2.5 million patients in the U.S. alone, lead to the deaths of about 60,000 of them a year, and cost about $10 billion to treat. Read More

    Machine Learning Yields Fresh Insights Into Pressure Injury Risks

    Big data and machine learning helped develop a model for predicting risk for pressure injuries in critical care patients, according to new research published in the November issue of American Journal of Critical Care (AJCC). In “Predicting Pressure Injury in Critical Care Patients: A Machine-Learning Model,” the research team examined five years of data on patients admitted to the adult surgical or surgical cardiovascular intensive care units at the University of Utah Hospital in Salt Lake City. Among the sample of 6,376 patients, hospital-acquired pressure injuries of stage 1 or greater developed in 516 patients, and injuries of stage 2 or greater developed in 257 patients. Read More

    Risk Factors of Intraoperative Pressure Injuries in Patients Undergoing Digestive Surgery: A Retrospective Study

    Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hours by the information system. The clinical data were collected to analyze risk factors of intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. Of 5136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72h follow-up. Preoperative skin under compression, preoperative physical activity, surgical position, and extra intraoperative pressure were considered independent risk factors of intraoperative pressure injuries.  Read More

    Evaluation of Fluorescence Biomodulation in the Real-Life Management of Chronic Wounds: the EUREKA Trial.

    Fluorescence biomodulation (FB), a form of photobiomodulation (PBM) that is also known as low energy level light (LELL), has become an increasingly used clinical tool to induce wound healing in wounds that remain recalcitrant to treatment. Read More

  • October 30, 2018

    The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice

    Diabetic peripheral polyneuropathy (DPNP) is the most common microvascular complication and an amputation risk factor in patients with diabetes. Therefore, early recognition and appropriate management of DPNP are important. Unfortunately, methods for DPNP detection are underutilized in primary-care practice and DPNP is underdiagnosed. To confirm the diagnosis, a nerve-conduction study or skin biopsy is required. However, these procedures are invasive and may be unsuitable for use in clinical practice. The identification of potential patients with DPNP, particularly by non-specialists, requires easily applicable and clinically reliable screening and diagnostic methods.  Read More

    Condom Catheter Induced Penile Skin Erosion

    Condom catheters are widely used in the management of male urinary incontinence, bedridden patient and geriatric population. They are considered to be safe, however, they are associated with complications in care of an incorrect use. In our hospital setup a 73-year-old male bedridden patient attended the surgical opd with complain of penile skin erosion following condom catheter application for 4 days for which dressing was done to remove the slough for 2 days then circumcision was done. Henceforth, although a less known complications are associated with the condom catheter but if not attended promptly can lead to a grave condition like penile gangrene, necrosis, death.  Read More

    Novel Combination Therapy Promotes Wound Healing

    By incorporating a gene-suppressing drug into an over-the-counter gel, researchers at Albert Einstein College of Medicine and their colleagues cut healing time by half and significantly improved healing outcomes compared to control treatments. Results from the combination therapy, which was tested in mice, were published online today in Advances in Wound Care. "Not only did wound healing occur more rapidly and completely, but actual regeneration occurred, with hair follicles and the skin's supportive collagen network restored in wounded skin—clinically important improvements that are unprecedented in wound care," says senior author David J. Sharp, Ph.D, professor of physiology & biophysics at Einstein. "We foresee this therapy having broad application for all sorts of wounds, from playground cuts to battlefield injuries to chronic wounds.  Read More

    Study Identifies Gene That Makes Gentle Touch Feel Painful After Injury

    Ever wonder why things that normally feel gentle, like putting on soft shirts, are painful after a sunburn? In a study of four patients with a rare genetic disorder, NIH researchers found that PIEZO2, a gene previously shown to control our sense of our bodies in space and gentle touch, may also be responsible for tactile allodynia: the skin's reaction to injury that makes normally gentle touches feel painful. This and a second NIH-funded study, both published in Science Translational Medicine, used mice to show how the gene may play an essential role in the nervous system's reaction to injury and inflammation, making PIEZO2 a target for developing precise treatments for relieving the pain caused by cuts, burns, and other skin injuries. Read More

  • October 22, 2018

    Thermal Imaging Improves Diabetes-Related Foot Ulcer Assessment

    Thermal imaging can better predict a diabetes related foot ulcer's size and the healing trajectory than conventional methods, Melbourne-led research has found. It could also possibly save money through better targeted treatment. The study, which was the first of its kind, was a collaboration between RMIT University, the University of Melbourne and Austin Health. It used thermal imaging to quantify the size and predict the healing status of recently developed ulcers. Read More

    How Fatal Biofilms Form

    By severely curtailing the effects of antibiotics, the formation of organized communities of bacterial cells known as biofilms can be deadly during surgeries and in urinary tract infections. Researchers have just come a lot closer to understanding how these biofilms develop, and potentially how to stop them. Biofilms form when bacterial cells gather and develop structures that bond them in a gooey substance. This glue can protect the cells from the outside world and allow them to form complex quasi-organisms. Biofilms can be found almost everywhere, including unwashed shower stalls or the surfaces of lakes. Because the protective shell can keep out potential treatments, biofilms are at their most dangerous when they invade human cells or form on sutures and catheters used in surgeries. Read More

    Combined Therapy in the Treatment of Mixed Etiology Leg Ulcer

    The most frequent causes of leg ulcers are chronic venous disease (CVD) related mainly to venous hypertension and peripheral arterial disease (PAD) related to disseminated atheromatous lesions in lower limb arteries. In 15%–21% of patients, ulcers of mixed venous-arterial etiology occur, which are usually more resistant for conservative therapy (compression therapy, pharmacotherapy, wearing elastic stockings, leg elevation and massage, change of lifestyle, and regular physical exercises).  Read More

    Advancements in Regenerative Strategies Through the Continuum of Burn Care

    Currently, multiple strategies exist for the management of burn wounds depending on both the depth and extent of the burn. Burn wound care strategies aim to modulate the inflammatory response, accelerate re-epithelialization, and improve overall wound healing. Furthermore, combinatorial approaches that incorporate cellular-based therapies, pharmacological agents, and biomaterials are utilized to minimize infection and serve as burn wound coverage adjuncts with the goal of restoration of skin function (i.e., barrier, range of motion, sensation, hair and sweat generation, and pigmentation). This review focuses on how therapies for burn injuries are currently being developed to address the array of issues that occur throughout the continuum of burn care. Read More

  • October 18, 2018

    Acting Fast Is Key with Necrotizing Fasciitis

    Necrotizing fasciitis is a bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels. The bacteria most commonly get into the body through a break in the skin. Once in the body, the bacteria spread quickly and destroy the tissue they infect. Media reports often call them “flesh eating bacteria.” Unfortunately, necrotizing fasciitis can result in a loss of limbs and even death. Accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping this infection. Read More

    UTA Researchers Patent Technology for Smart Seat Cushion, Adaptable Prosthetics

    The University of Texas at Arlington has patented a smart seat cushion that uses changes in air pressure to redistribute body weight and help prevent the painful ulcers caused by sitting for long periods of time in a wheelchair. The same technology can be used to create prosthetic liners that adapt their shape to accommodate changes in body volume during the day and maintain a comfortable fit for the prosthesis. Poor prosthetic fit can cause skin damage and create sores in the residual limb of the wearer. Read More

    Photoactive Bacteria Bait May Help in Fight Against MRSA Infections

    Purdue University researchers are testing whether a simple light-emitting diode array that is safe to use on human skin can be used to inactivate methicillin-resistant Staphylococcus aureus, or MRSA, one of six 'high priority' pathogens that the World Health Organization has identified as an imminent threat to public health. Here the light shines above a 96-well plate in a bio-safety hood. Read More

    Diabetic Foot Disease

    Diabetic foot disease is a severe complication of neuropathy and/or peripheral vascular disease and can lead to chronic infection, foot ulcers, gangrene, and lower-limb amputation. Every year, about 1% to 4% of people with diabetes develop a new foot ulcer. A foot ulcer is the initial event in more than 85% of amputations performed on those with diabetes. Although the rate of foot and leg amputation has greatly declined over the past 2 decades, increasing awareness is essential because diabetes is the leading cause of lower-limb amputations in the United States. Read More