The Effect of COVID-19 on Care for Chronic Wounds Among Medicare Beneficiaries Using Medicare Claims - 2019, 2020, and 2021

Objectives: Examine the effect of COVID-19 on chronic wound care service provision for Medicare beneficiaries in 2019, 2020, and 2021. Method(s): This retrospective analysis of Medicare claims data included beneficiaries who received care for diabetic foot ulcers and infections, arterial ulcers;skin disorders and infections, surgical wounds and infections;traumatic wounds;venous ulcers and infections, unspecified chronic ulcers, and others. We extracted all claims for each targeted beneficiary across all care settings and from the Medicare Beneficiary Summary File for 2019 to 2021. The outcomes were: 1) prevalence of each wound type, 2) Medicare expenditures by wound type, and expenditures by type of service. Result(s): Over the 3-year period, the number of Medicare beneficiaries with a wound generally decreased in 2020, then increased in 2021 to a higher level than in 2019. In 2019, 16.4% of Medicare beneficiaries (10.6M) had at least one type of wound. In 2020, 14.9% of Medicare beneficiaries (9.8M) were diagnosed with wounds (a decrease of 7.1%), and in 2021, 16.1% of Medicare beneficiaries (10.8M) were diagnosed with wounds, an increase of 1.9% from 2019. In 2021, approximately 2.7% of beneficiaries had a claim with a wound diagnosis that had been added in FY2020, or 0.4% of all Medicare beneficiaries. The prevalence of COVID-19 among beneficiaries with chronic wounds was 896,198 (9.1%) in 2020, rising to 1.2M (11.1%) in 2021. Using our mid-range estimates of Medicare expenditures, wound care totaled $24.7B in 2019, $23.9B in 2020, and $26.3B in 2021. Conclusion(s): These results emphasize the ongoing prevalence of chronic wounds among Medicare beneficiaries and suggest the decrease in care during the pandemic contributed to a relative increase in care and expenditures in 2021. We found a shift in the site of care from skilled nursing facilities toward home health as individuals sought to avoid COVID-19 exposure.Copyright © 2023

Anti-IL17A, Ixekizumab, for treatment-resistant chronic venous leg ulcers: A phase II randomized, double-blind, placebo-controlled pilot trial

Chronic venous leg ulcers cause significant morbidity in patients and the majority reoccur after resolution. The current standard of care, double layer compression, is not effective in all patients. Interleukin 17A (IL17) antagonist therapy has been shown to promote healing in murine models of chronic wounds. This has not previously been explored in humans. Therefore, we aim to undertake a phase II randomized, double-blinded, placebo-controlled pilot trial to assess whether Ixekizumab, an anti-IL17A therapy, is effective at reducing chronic venous ulcer size. In addition, to determine the feasibility and safety of undertaking a randomized control trial. Patients with a venous leg ulcer not responsive to 4 weeks of compression therapy were recruited. Participant were randomized to receive either Ixekizumab (80mg) or placebo injected subcutaneously every fortnight for 12 weeks while continuing standard of care. From 30 eligible, 4 patients consented, were enrolled and randomized. Initially, COVID-19 risk, medical history and distance from recruiting site were the main causes of exclusion or refusal to participate. All participants completed the 12-week treatment period. At completion, two participants in the Ixekizumab group reduced by >40% and one completely resolved their ulcer. Ulcers in the Ixekizumab group reduced by an average size of 955mm2 to 529mm2at baseline to final review respectively (p-value 0.12). The placebo group reduced in size by <5%.There were no adverse events related to the intervention. This pilot clinical trial investigated a novel treatment for chronic venous ulcers and showed IL17 inhibition does not impede and may improve chronic wound healing. It also showed a lack of major safety issues in using anti-IL17A therapy in this population. Moreover, the findings reinforce the feasibility of a larger trial to more accurately evaluate anti-inflammatory strategies in chronic wounds.Copyright © 2023

In situ electrospun aloe-nanofiber membrane for chronic wound healing.

Alleviating excessive inflammation while accelerating chronic wound healing to prevent wound infection has remained challenging, especially during the coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 when patients experienced difficulties with receive appropriate healthcare. We addressed this issue by developing handheld electrospun aloe-nanofiber membranes (ANFMs) with convenient, environmentally friendly properties and a therapeutic capacity for wound closure. Our results showed that ANFMs fabricated with high molecular weight polyvinyl alcohol (PVA) to form fibers during electrospinning had uniform fibrous architecture and a porous structure. Given the value of aloe gel in accelerating wound healing, liquid extracts from ANFMs significantly downregulated the expression of the pro-inflammatory genes, interleukin-6 (IL-6) and inducible nitric oxide synthase (iNOS), and markedly suppress the generation of reactive oxygen species (ROS) induced by lipopolysaccharide in RAW264.7 macrophages. These results indicated the excellent antioxidant and anti-inflammatory effects of ANFMs. After implantation into a mouse diabetic wound model for 12 days in situ, ANFMs notably expedited chronic wound healing via promoting angiogenesis and enhancing cell viability. Our ANFMs generated by handheld electrospinning in situ healed chronic wounds offer a convenient and promising alternative for patients to heal their own wounds under variable conditions.

Role of antiseptics in the prevention and treatment of infections in nursing homes.

Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.

Home Care and the Effects of Hypericum tetrapterum Oil Extract in the Treatment of Chronic Wounds During the COVID-19 Pandemic.

The COVID-19 pandemic and the need for social distancing brought about sudden changes in the health system and treatment strategies. Patients with chronic wounds were affected by these changes and had limited access to professional treatment in hospitals. They were at a higher risk of infection with COVID-19 due to comorbidities and advanced age. The aim of the study was to develop an appropriate protocol for the in-home treatment of chronic wounds due to the COVID-19 pandemic when access to hospitals is limited and the risk of infection for these patients is high. In our case, Hypericum tetrapterum oil extract was applied for four months on a volunteer, a 78-year-old male patient with a chronic wound, additionally infected with Pseudomonas aeruginosa and comorbidities. His healing status was monitored by measuring the wound size and microbiological analysis at certain intervals. The scab of wound DPHR2 (right lower leg chronic wound 2), with its diameters of d1 (40 mm) and d2 (20 mm), fell off after 22 days of the first Hypericum tetrapterum oil extract application. The scab of wound DPHR1 (right lower leg chronic wound 1), with its diameters of d1 (74 mm) and d2 (35 mm), fell off after two and a half months of treatment with Hypericum tetrapterum oil extract. The results of our study indicated that Hypericum tetrapterum oil extract has a significant wound-healing potential and might be used as traditional medicine in the treatment of chronic wounds.

Recent Advances in Silver Nanoparticles Containing Nanofibers for Chronic Wound Management.

Infections are the primary cause of death from burns and diabetic wounds. The clinical difficulty of treating wound infections with conventional antibiotics has progressively increased and reached a critical level, necessitating a paradigm change for enhanced chronic wound care. The most prevalent bacterium linked with these infections is Staphylococcus aureus, and the advent of community-associated methicillin-resistant Staphylococcus aureus has posed a substantial therapeutic challenge. Most existing wound dressings are ineffective and suffer from constraints such as insufficient antibacterial activity, toxicity, failure to supply enough moisture to the wound, and poor mechanical performance. Using ineffective wound dressings might prolong the healing process of a wound. To meet this requirement, nanoscale scaffolds with their desirable qualities, which include the potential to distribute bioactive agents, a large surface area, enhanced mechanical capabilities, the ability to imitate the extracellular matrix (ECM), and high porosity, have attracted considerable interest. The incorporation of nanoparticles into nanofiber scaffolds constitutes a novel approach to "nanoparticle dressing" that has acquired significant popularity for wound healing. Due to their remarkable antibacterial capabilities, silver nanoparticles are attractive materials for wound healing. This review focuses on the therapeutic applications of nanofiber wound dressings containing Ag-NPs and their potential to revolutionize wound healing.

Health Education In The Self Care Process Of The Chronic Wounds Healing Of The Diabetic Foot

Purpose/Objectives: The increase in life expectancy in recent years is closely related to scientific advances in health area. Thus, longevity led to a greater emergence of chronic diseases, such as diabetes mellitus (DM). In this scenario, chronic wounds represent a serious public health problem. It is estimated that 85% of lower extremity amputations in individuals with DM are related to the presence of foot ulcers. The perception of changes in the skin, such as deformities, superficial traumas and cracks, is impaired in diabetics due to loss of sensitivity, predisposing the appearance of wounds. Ulcers and other injuries can be prevented through simple measures, such as regular skin inspection, specialized care and the use of adequate footwear;as the greater understanding of self-care, the greater the benefits of treatment. In this sense, Primary Care is an effective mean of assisting such individuals, as health education actions can be carried out for this population, their families and caregivers, with a view of promoting health. In addition, the health education process must take place in parallel with medication and dressings, which are essential, especially the latter, given the specificity of the product and the level of tissue regeneration. The primary objective of this study is to present the educational activities developed by the Extension Project Physiotherapy in the Community of the State University of Paraíba in partnership with the research project Tissue Engineering in Epithelial Repair: Biodegradable Scaffold for Tissue Regeneration, which is developing chitosan/Jatropha mollissima scaffolds, in the Laboratory of Evaluation and Development of Biomaterials from the Northeast of the Federal University of Campina Grande. Methodology: The participants consisted of users of Basic Health Units (BHU) in the city of Campina Grande/Paraiba/Brazil. The educational material on Diabetes and Diabetic Foot Wound Care was produced from documents such as articles, guidelines and booklets. The CANVA application was used to create the images and infographics, to facilitate the understanding of the participants, and it was sent along with an explanatory audio. The disclosure took place on the public profile on Instagram @fisionacomunidadeuepb and also through the WhatsApp application for the diabetic elderly who participate in the project, in addition to face-to-face meetings at BHU, to clarify doubts at previously scheduled times and with a limited number of people due to the covid 19 pandemic. Results: The results included a greater understanding of the process of illness and wound development, as well as awareness of the importance of adherence to treatment and care in the use of dressings, especially. According to the records, the participation in the means used was intense, which suggests that these people will also be multipliers in the health education process. Conclusion/Significance: It is concluded that health education strategies, even at the time of a pandemic, are useful in the process of correct information dissemination, helping the most vulnerable population to understand their disease and, at the same time, help them in self care and responsibility, thus facilitating the intervention used by the health and engineering team.

Assessing the natural history of recessive dystrophic epidermolysis bullosa wounds using a home photography app

Recessive dystrophic epidermolysis bullosa (RDEB) is a devastating, genetic, blistering condition caused by the absence of type VII collagen (C7) resulting in wounding. One major barrier to clinical trial development is the lack of understanding of the natural history of RDEB wounds, as the measurement of wound change has not been studied prospectively or validated. We conducted a longitudinal observational study of 13 participants with RDEB, that were not currently participating in interventional clinical trials. They used a mobile phone photography application with built-in machine learning to outline and track RDEB wounds autonomously. Participants used this mobile application to capture weekly photographs of chronic or recurrent wounds for up to six months and reported associated pain and itch. In total, 773 photos were collected from 72 wounds, of which 39 were chronic wounds (54.2%). The median time for wound closure (≥90% decrease in size from the first photo) was 249 days for chronic open wounds and 68 days for recurrent wounds. A chronic open wound was defined as a wound that has not healed for more than 12 weeks and a recurrent wound heals in less than 12 weeks, but re-opens. For chronic open wounds, wound size was positively correlated with pain and itch using spearman correlation coefficients (0.76, p<0.001 and 0.74, p<0.001, respectively). Wound size for recurrent wounds were also positively associated with pain and itch (0.37, p<0.001;0.32, p<0.005). The COVID-19 travel restrictions have shown the value of remote wound monitoring to assess the natural history of RDEB wounds. Challenges included patient difficulties in navigating the mobile application, uploading regularly, and limited participation due to enrollment in other clinical trials. The next step of this work is to compare our findings of the closure time for chronic versus recurrent wounds against published wound size data of 60 participants from a recent clinical trial, which will enable our group to test definitions of chronic and recurrent wound duration.

Determiners of pressure ulcers formation – analyses from hospital information system

Introductions: Pressure ulcers (PUs) represents an undesirable complication during hospitalization. Aim: Retrospective data analysis to verify the prevalence of PUs since 2015 (since the mandatory registration of the PUs an adverse event) by principal diagnosis, type of surgery and length of hospital stay in the period 2015–2021. Sample and methods: Retrospective analysis of data from the hospital information system (HIS), at 0.05 level of significance (T-Test) with the variables: age, number of pressure ulcers, principal diagnosis, operation, length of hospitalization and prevalence of COVID-19 to length of hospitalization. Results: A total of 2,350 PU cases in 1,539 patients (1.52 PUs/patient) were registered in the HIS, and 930 (40%) patients were admitted to hospital with PUs. The most common locations of PUs were: heel (33%), sacrum 6% less, buttocks (17%). Between 2015 and 2021;17,247 patients were operated on, of whom 289 had a Pus. The most common principal diagnosis in the occurrence of PUS was femoral neck fracture (14.35%) and neurological (9.09%) or oncological disease (12.03%). The incidence of PUs was surprising in patients with ileal conditions (11.57%). COVID-19 was found in 163 patients in 2020 and 2021, six of whom had PUs and prolonged hospitalization. Conclusion: It is important to view the health status of people with chronic wounds and PUs in a comprehensive manner and to develop an individualized care plan to improve patients‘ lives and chances of recovery.

Challenges faced by doctors and nurses in wound care management during the COVID-19 pandemic in Turkey and their views on telehealth.

AIM: This study aimed to determine the problems faced by physicians and nurses dealing with chronic wound care during the COVID-19 pandemic and their views on telehealth. MATERIALS AND METHODS: A descriptive and cross-sectional design was used in this study. The sample comprised physicians (n = 74) and nurses (n = 271) interested in chronic wound care. Data were collected through a questionnaire form consisting of open- and closed-ended questions. RESULTS: Of the participants, 21.4% (n = 74) were physicians and 78.6% (n = 271) were nurses. Of the physicians, 45.9% (n = 34) were obliged to work in another unit during the COVID-19 period, while 43.2% continued their service related to chronic wound care, and only 17.0% (n = 18) in the wound care service before the pandemic. These rates are 51.3% (n = 139), 51.6% (n = 157) and 36.8% (n = 128) for nurses, respectively. 40.7% of the physicians (n = 33) and 34.9% of the nurses (n = 106) stated that their time had been reduced for chronic wound care. When the telehealth experiences were examined, 32.4% (n = 24) of the physicians utilized telehealth, 29.7% (n = 22) used e-visit, 77.0% (n = 57) stated that they thought telehealth was a good option, 47.3% (n = 35) utilized it for wound evaluation and treatment, and 31.9% (n = 59) used smart phones. These rates for nurses were 16.6% (n = 45), 14.0% (n = 38), 72.7% (n = 197), 33.9% (n = 92), and 27.0% (n = 182), respectively. CONCLUSIONS: The COVID-19 pandemic negatively affected the manner of delivery, duration, and quality of service regarding wound management. During this period, face-to-face contact times with patients were reduced, some diagnosis and treatment attempts were not performed, and wound care services were suspended temporarily or permanently. On the other hand, a positive result was achieved in that the physicians and nurses gave positive feedback for the telehealth experience.

The Impact of COVID-19 Pandemic on Vascular Leg Ulcers.

The aim of this study was to evaluate the impact of 2 lockdown periods during coronavirus disease 2019 (COVID-19) on the course and management of nonhealing vascular ulcers of lower limbs. A total of 41 patients were included in the study. Before the pandemic began they had been seen at our unit at weekly intervals. During lockdown from March 9, 2020, to May 18, 2020 subjects were not allowed to enter the hospital unless they needed urgency or emergency surgery, or oncological management. During the second lockdown, from October 19, 2020, to December 11, 2020 patients could be followed up at distance by direct outreach including telephoning contacts. Data obtained early after each lockdown were compared with those obtained prior to the pandemic. Data for the first lockdown show that pain intensified and there was an increase in the recurrence rate of wounds, of their severity, and of superimposed infections as compared with the prelockdown period. The risk of lower-limb amputation was also considerably greater. During the second and less restrictive lockdown, patients were followed up by telemedicine and data indicate that skin lesions had not worsened any further. The management of vascular wounds was impacted by the pandemic unfavorably with health care failures in the hospital as well as in the primary care settings. In conclusion, the treatment of vascular leg ulcers is challenged by the COVID-19 pandemic as this spreads worldwide. This seems to be in keeping with what happens for other diseases. The data we obtained indicate that the pandemic-related lockdown has a deleterious effect on vascular skin wounds, with an increase of severity and mortality risk. The impact appears to be proportional to the number and the degree of limitations imposed on people.

Investigation of the status and influence factors of caregiver's quality of life on caring for patients with chronic wound during COVID-19 epidemic.

The objectives of this study were to investigate the status and influence factors of caregiver's quality of life (QOL) on caring for patients with chronic wound during COVID-19 epidemic. A prospective cross-sectional study of 83 informal caregivers was included. The characteristics of informal caregivers as well as their QOL assessment by the Family Dermatology Life Quality Index (FDLQI) were measured, respectively. Single-factor analysis and multiple regression analysis were carried out to explore the independent influence factors of QOL of caregiver on caring for patient with chronic wound. 62.65% of the caregivers were female with a mean age of (54.24 ± 12.6) years, and 34.9% of the caregivers were parents. The mean FDLQI score was 13.01 ± 7.53 at a high level. The following variables influenced the FDLQI scores of caregivers: self-care ability of patients, patient's satisfaction of home-based wound care, and home-based wound care need of caregivers. The model was able to explain 29.9% of variance in QOL of caregiver (F = 6.561, P = .000, R2  = 0.299, adjusted R2  = 0.253). In conclusion, the impact of chronic wound disease on the QOL of caregivers is heavy during COVID-19 epidemic. Wound professionals are suggested to pay attention to wound care need at home and QOL of caregiver on caring for patients with chronic wound during COVID-19 epidemic and develop tailored wound health education and support programme in order to improve the QOL of caregivers.

[Pay attention to the exposure risk of patients with chronic wounds on the way to hospital during coronavirus disease 2019 epidemic prevention and control].

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%. Among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of coronavirus disease 2019 released by National Health Commission of China. It is an unavoidable fact that the patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that quite a few patients preferred going far afield in choosing hospital for treatment due to various reasons. During the prevention and control of coronavirus epidemic, this " go far afield" style of seeking medical treatment may increase the exposure risk during travelling. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the " Five Measures" encouraging the patients with chronic wounds to seek medical treatment nearby. The principle of this operation is that when seeking medical treatment, patients with chronic wounds should try their best to reduce the travel distance as much as possible to minimize the exposure risk during the epidemic period, which will in turn support the campaign of epidemic prevention and control.

Attention should be paid to the exposure risk of patients with chronic wounds on the way to hospital during corona virus disease 2019 epidemic prevention and control / 中华烧伤杂志

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.