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Featured Articles

  • December 19, 2018

    Jump in Amputations Linked to Diabetes 

    The number of diabetes-related lower limb amputations has jumped by nearly a fifth in England over recent years, a leading charity has warned. According to Diabetes UK, 26,378 amputations were carried out between 2014 and 2017, up from 22,092 between 2010 and 2013 - an increase of 19.4%. There has been a significant rise in minor lower limb amputations (26.5%), defined as below the ankle, and a more gradual increase in the number of major lower limb amputations (4.1%), defined as below the knee. Read More

    Skin Deep: A Closer Look at Treatment of Skin and Soft Tissue Infections

    Current guidelines for management of Skin/Soft Tissue Infections (SSTIs) were published in 20141.  Nevertheless, management of SSTIs is variable, likely driven by the fact that culture data is often unavailable to direct clinical decision making. Treatment variability results in inappropriate antimicrobial use, highlighting the need for antimicrobial stewardship. Consequently, management of SSTIs is one area where more research has identified easy targets for improvement. This review describes two such studies. Read More

    URGO Group Receives the 'Prix Galien France 2018' for UrgoStart®, an Innovative Treatment for Diabetic Foot Wound Healing

    With one amputation carried out every 20 seconds, diabetes is the world's leading cause of amputation. In light of this finding, Urgo Medical launched the Explorer clinical study in France, Spain, Italy, Germany and the UK, with the  outcomes published in March 2018 in The Lancet Diabetes & Endocrinology. The results demonstrated the efficacy of UrgoStart® which led to a 60% increase in wound closure compared with standard care and reduced wound closure time by 60 days from an average period of 180 days.   Read More

    Fighting Operating Room Staphylococcus aureus Transmission—What Are We Missing?

    Investigators on a new study have found that high-risk pathogenic sequence types of Staphylococcus aureus are highly transmissible between patient procedures in the operating room, prompting a call for improved hand hygiene and patient decolonization compliance. The operating room is a tough area to maintain sterility and cleanliness. The operating theater is large, filled with items, and inherently poses a unique risk for surgical site infections. Furthermore, frequent traffic in and out, gross spillage, attire inconsistency, the race to clean and prep the room for the next case upon operating completion, and more, are all things that facilitate germ transmission and complicate infection prevention within this environment. Read More

  • December 12, 2018

    Shape-Shifting Cell Breakthrough 

    A new computational model developed by researchers from The City College of New York and Yale gives a clearer picture of the structure and mechanics of soft, shape-changing cells that could provide a better understanding of cancerous tumor growth, wound healing, and embryonic development. Read More

    New Insole Uses Oxygen to Help Heal Diabetes-Related Foot Ulcers

    When it comes to treating, managing, and preventing diabetes-related complications, it seems oxygen is a key ingredient. Along that line, researchers at Purdue University have created a customizable insole to treat diabetic foot ulcers. It’s similar to evolving medical technology with contact lenses that help prevent and treat diabetic retinopathy. Read More

    New ATTRACT Data Show Catheter-Based Therapy Significantly Reduces Leg Symptoms and PTS Severity to Two Years

    A new study, recently published online in the journal Circulation, reports on outcomes from a subgroup of 391 patients with acute iliofemoral deep venous thrombosis (DVT) in whom pharmacomechanical catheter-directed thrombolysis (PCDT) was evaluated within the ATTRACT trial.  Read More

    Carriage of ESBL-PE May Increase the Risk of Colorectal Surgical Site Infections

    Although the 2013 Infectious Diseases Society of America and 2017 US Centers for Disease Control and Prevention (CDC) guidelines recommend a combination of oral antimicrobials, mechanical bowel preparation (MBP), and intravenous (IV) cephalosporin and metronidazole for colorectal surgical prophylaxis, screening for extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) in high-risk patients and coverage are not included. Despite the high rates of morbidity and mortality with ESBL-PE infections, little is known about the prevalence of ESBL-PE fecal carriage and its effect on rates of surgical site infections (SSIs) after colorectal surgery. Read More

  • December 5, 2018

    Diacerein Ointment Could Be Safe Treatment for Generalized Severe EBS, Study Suggests

    A 1% diacerein ointment could be a safe and well-tolerated way to treat generalized severe epidermolysis bullosa simplex (EBS), according to a study involving two boys treated for four weeks. In vitro data suggested that the diacerein ointment was retained in the skin for a prolonged period of time. The study, “Basal pharmacokinetic parameters of topically applied diacerein in pediatric patients with generalized severe epidermolysis bullosa simplex,” was published in the Orphanet Journal of Rare Diseases. Read More

    Wound-Healing Cell May Be Cancer Key

    UCLA scientists have discovered a protein factor that helps a fibroblast cell’s ability to help in wound healing. Fibroblasts are cells found in connective tissues of the body. In response to a wound, they migrate toward and spread through molecular changes. Such proliferation is linked with the reprogramming of gene expression patterns. To understand how fibroblast cells migrate, the UCLA team used RNA sequencing, imaging, primary human cells isolated from skin, cancer cell lines and mouse modeling. Researchers found that proliferating cells adjacent to wounds express higher levels of cleavage and polyadenylation factors than fibroblasts in unwounded skin. Read More

    Stimulating Fibroblasts Can Trigger Hair Growth in Wound Healing

    Stimulating fibroblasts through the sonic hedgehog pathway can trigger hair growth not previously seen in wound healing. By stirring crosstalk among skin cells that form the roots of hair, researchers report they have regrown hair strands on damaged skin. The findings better explain why hair does not normally grow on wounded skin and may help in the search for better drugs to restore hair growth, say the study’s authors. Led by researchers at NYU School of Medicine the study examined the effect of distinct signalling pathways in damaged skin of laboratory mice. Experiments focused on cells called fibroblasts that secrete collagen, the structural protein most responsible for maintaining the shape and strength of skin and hair.  Read More

    It's Not a Shock: Better Bandage Promotes Powerful Healing

    A new device powered by energy harvested from the body’s natural motions accelerates wound healing by delivering gentle electric pulses to an injury site. A new, low-cost wound dressing developed by University of Wisconsin-Madison engineers could dramatically speed up healing in a surprising way. The method leverages energy generated from a patient's own body motions to apply gentle electrical pulses at the site of an injury. In rodent tests, the dressings reduced healing times to a mere three days compared to nearly two weeks for the normal healing process. "We were surprised to see such a fast recovery rate," says Xudong Wang, a professor of materials science and engineering at UW-Madison. "We suspected that the devices would produce some effect, but the magnitude was much more than we expected." Read More

  • November 27, 2018

    Predicting Pressure Injuries with Machine Learning, EHR Data

    Fueled by EHR data, machine learning tools have shown potential in improving several areas of care delivery, including sepsis prediction, chronic disease management, and cancer detection. As providers increasingly experience financial pressure to ensure patient safety, more organizations are seeking to use big data analytics tools to predict and prevent hospital-acquired conditions and potentially deadly infections. Hospital-acquired pressure injuries are one area where researchers are applying these advanced technologies. Pressure injuries are prevalent among patients in intensive care units (ICUs), occurring in eight to ten percent of critical care patients. These injuries are also associated with longer hospital stays, more patient suffering, and increased healthcare costs. Read More

    Researchers Assess Trends in Efficacy of Antibiotic Prophylaxis Regimens for Surgical Procedures

    Antibiotic prophylaxis regimens are becoming less effective at preventing surgical site infections following colorectal surgery, researchers at the Center for Disease Dynamics, Economics & Policy and Princeton University determined through a systematic review of available literature. The researchers also found that the efficacy of antibiotic prophylaxis in preventing infection following appendectomy, cesarean section, and transrectal prostate biopsy (TRPB) procedures has remained statistically unchanged, although this analysis was challenged by small sample size. Read More

    Vitamin D Deficiency and Diabetic Peripheral Neuropathy

    According to the American Diabetes Association, up to 50% of diabetic peripheral neuropathies may be asymptomatic. This is called painless neuropathy and patients with this type of neuropathy are at risk of injuries and diabetic foot ulcerations. Previous research studies linking vitamin D deficiency and diabetic peripheral neuropathy did not distinguish between painless and painful diabetic peripheral neuropathy. The following study focuses on these distinctions and other confounding factors like sunlight exposure and patient activity levels.  Read More

    Vasculitis Remission Predicts Long-Term Risks

    Early and sustained remission may be a useful predictor of long-term mortality and end-stage renal failure (ESRF) among patients with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV), a study by the European Vasculitis Society suggested. Among patients with AAV included in four inception trials from 1995 to 2002, outcomes at 6 months were retrospectively categorized as sustained remission (remission by month 3 and sustained at month 6), late remission (remission after month 3 and by month 6), relapsing disease (remission by month 3 but relapse by month 6), and refractory disease (no remission by month 6), according to Seerapani Gopaluni, MBBS, of the University of Cambridge in England, and colleagues. Read More

  • 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