ABSTRACT
IMPORTANCE: Chronic wounds usually get trapped in the inflammatory stage of wound healing; however, aggressive debridement transforms chronic wounds to acute wounds and therefore complete healing. OBJECTIVE: To investigate healing outcomes and debridement frequency in a large wound data set. DESIGN: Retrospective cohort study. SETTING: Data collected from 525 wound care centers from June 1, 2008, through June 31, 2012, using a web-based clinical management system. PATIENTS: Referred sample of 154 644 patients with 312 744 wounds of all causes (of an initial data set of 364 534 wounds) participated. A total of 47.1% were male. Median age was 69 years (age range, 19-112 years), with 59.2% having one wound. Eligibility criteria included age older than 18 years, receiving at least 1 debridement, and having been discharged from the system. Advanced therapeutic treatment was ineligible. Because of incomplete, questionable, or ineligible data, 57 190 wounds were not included. Most wounds were diabetic foot ulcers (19.0%), venous leg ulcers (26.1%), and pressure ulcers (16.2%). INTERVENTION: Debridement (removal of necrotic tissue and foreign bodies from the wound) at different frequencies. MAIN OUTCOME AND MEASURE: Wound healing (completely epithelialized with dimensions at 0 × 0 × 0 cm). RESULTS: A total of 70.8% of wounds healed. The median number of debridements was 2 (range, 1-138). Frequent debridement healed more wounds in a shorter time (P < .001). In regression analysis, significant variables included male sex, physician category, wound type, increased patient age, and increased wound age, area, and depth. The odds ratio varied considerably for each variable. CONCLUSIONS AND RELEVANCE: The more frequent the debridements, the better the healing outcome. Although limited by retrospective data, this study's strength was the analysis of the largest wound data set to date.
Subject(s)
Debridement/methods , Wound Healing , Wounds and Injuries/therapy , Acute Disease , Adult , Age Factors , Aged , Aged, 80 and over , Chronic Disease , Cohort Studies , Databases, Factual , Female , Humans , Male , Middle Aged , Regression Analysis , Retrospective Studies , Sex Factors , Time Factors , Treatment Outcome , Wounds and Injuries/pathology , Young AdultABSTRACT
The varied clinical applications for hyperbaric oxygen therapy have led to the development of a unique, highly skilled nursing specialty of hyperbaric nursing. The ever-increasing availability of hyperbaric medicine and the broadening scope of clinical indications have fueled the need for highly skilled hyperbaric nurses.
Subject(s)
Clinical Competence , Critical Care Nursing/education , Education, Nursing, Continuing , Hyperbaric Oxygenation/nursing , Critical Illness/nursing , Female , Humans , Hyperbaric Oxygenation/methods , MaleABSTRACT
OBJECTIVE: To determine whether patients with Wagner grades 1 and 2 diabetic foot ulcers (DFUs) or venous leg ulcers (VLUs) differed in terms of time to close depending on visit frequency to wound care centers. DESIGN: Retrospective cohort study. SETTING: Outpatients wound care centers. PATIENTS: Two hundred six patients with Wagner grade 1 or 2 DFUs and 215 patients with VLUs in the lower extremities collected from 9 wound care centers in 5 states (6 states for VLUs) during 2009/2010 and whose wounds had closed. INTERVENTIONS: For each type of DFU/VLU, 1 group had every-other-week visits, defined as more than 10 days between visits in the first 4 weeks, whereas the other group had weekly visits, defined as at least once a week. MAIN OUTCOMES MEASURES: Median time to close. MAIN RESULTS: For patients with DFUs, 63.8% of wounds had closed in the weekly visit group after 4 weeks compared with 2.0% in the every-other-week group (P = 2.3 × 10); for patients with VLUs, 78 of 105 wounds (52%) closed in the weekly visit group compared with 0% in the every-other-week group (P = 2.40 × 10). After controlling for all covariates in a Cox regression model, median time to close for weekly patients was 28 days versus 66 days for patients seen every other week. Adjusted median times to close VLUs in the same groups were 25 versus 55 days. CONCLUSIONS: More frequent visits can be extremely beneficial, with implications of lower costs and higher quality of life for patients.
Subject(s)
Ambulatory Care , Diabetic Foot/therapy , Varicose Ulcer/therapy , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Wound HealingABSTRACT
 Doxycycline is a semisynthetic, chemically modified tetracycline compound that is rapidly absorbed and exerts biological effects independent of its antimicrobial activity. One such effect includes the inhibition of matrix metalloproteinases. Doxycycline has a long history as a collagenase inhibitor. This article will describe its mode of action and review its effectiveness in significantly reducing inflammation and elevated levels of proinflammatory cytokines within chronic wounds. .
