Unexpected economics of ulcer care protocols.

The cost of managing chronic ulcers, both venous leg and decubiti (sacral pressure), was reviewed using 36 randomized, controlled studies with a focus on saline, hydrocolloid, and a human skin construct. When one includes the labor intensiveness of dressing changes three to four times per day, the application of hydrocolloid dressings becomes the most cost-effective.

Role of race and sex in diagnosis and one-year follow up of deep venous thrombosis.

This study examines the role of sex and race in the diagnosis and outcome of deep vein thrombosis (DVT). A retrospective study was performed of 632 patients who underwent venous duplex ultrasound from August 1998 to July 1999. Comparisons were made by Chi-square analysis. Seventy-four percent of the patients were women and 79% of the total group was African American. Twenty-two percent (140) of the examinations were positive for DVT. Of all studies performed in men, 37% were positive for DVT, and of all studies performed in women, 18% were positive for DVT (P<0.05). Additionally, African-American women were more likely to be positive for DVT than Caucasian women. One-year follow up showed that 42% had residual thrombus and, regardless of sex, African-Americans were more likely to have persistent thrombus than Caucasians (60% vs. 19%). Findings in this study suggest, in our cohort, African American women were diagnosed with DVT twice as often as Caucasian women and African Americans were more likely to have a persistent DVT as compared to Caucasians.

Economics of quality ulcer care.

Venous leg ulcers may affect up to 3.5% of the general patient population. The purchase price for dressing is not the true indication of cost effectiveness of any given method of care; rather cost is a combination of the price of the dressing plus labor required. Total cost equals nursing time, physician time, hospital stay, home-health costs, risks, and costs of complications (for example, infection), and the frequency of dressing changes.

Wound care after radiation therapy.

More than 50% of all cancer patients receive some form of radiotherapy for tumor control preoperatively, postoperatively, or as sole treatment. Radiation-induced wounds are a concern for patients and practitioners. Current research investigating alternative treatment strategies offers the hope of improved wound healing and enhanced quality of life for patients with these wounds. This paper reviews the pathophysiology of wounds following radiation treatment, the methods for treating radiation-induced wounds, and experimental treatment strategies that have been investigated.

The silent worker.

The patient in this case was diagnosed as having a myocardial infarction, exacerbated over time. It has been reported in medical literature that women in such cases may have atypical symptoms that mimic those of other medical conditions and deceive providers into misdiagnosis. A few women present with the classical chest pain, a symptom most people relate to a feeling of a heart attack. This symptom is more typical in males. EMS providers should have a high suspicion of heart disease in any patient who describes their symptoms as common or relative to acute coronary syndromes. Patients at risk include those with high blood pressure, coronary artery disease, increased cholesterol, obesity and diabetes, among others. Given that this patient was resting comfortably and complaining of abdominal pain, the providers could have interpreted her symptoms as mere gastrointestinal discomfort. In this instance, that could have led to an error in diagnosis and serious complications. The receiving ED could have had a cardiac arrest to manage rather than an early, silent acute coronary event. In this instance, contacting medical command, obtaining a focused history and providing general treatment contributed to a positive outcome for the patient.

Development of a severity scale for evaluating the need for Graftskin in nonhealing venous ulcers.

OBJECTIVE: To construct an easy-to-use severity scale based on data from a multicenter venous leg ulcer trial to predict which wounds will progress toward closure and which will remain unhealed. DESIGN: Factors that have an impact on wound healing (eg, ulcer duration, depth, area, location, and fibrin) were identified in the literature. A severity scale was constructed based on these factors. SETTING: Multicenter clinical trial. PATIENTS: 240 patients with venous leg ulcers of longer than 1 month's duration. MAIN RESULTS: Wound duration and area were identified as having the greatest impact on ulcer healing. Using multivariate regression analyses, a wound score of 8 or less was considered mild to moderate. A severe wound, having a score of 9 or greater, was found to be unlikely to heal with compression therapy alone. CONCLUSION: This severity scale can serve as an adjunctive tool in the prompt identification of ulcers with a poor healing prognosis and enable early intervention with alternate therapies. To optimize the severity scale, future trials should incorporate a method to review the interaction of known factors that impair wound healing.

Validation of venous leg ulcer guidelines in the United States and United Kingdom.

BACKGROUND: Venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of 3 billion dollars and loss of 2 million workdays per year. The purpose of this study was to validate the clinical efficacy and cost effectiveness of multidisciplinary guidelines for the diagnosis and treatment of venous leg ulcers. METHODS: Eighty (40 retrospective, 40 prospective) patients from the United States and United Kingdom were enrolled. RESULTS: United States patients were 6.5 times and United Kingdom 2 times more likely to heal if a guideline was followed (P <0.001). A significant decrease was noted in healing time for both the United States and United Kingdom (P <0.01), and the median cost decreased significantly when the guideline was followed (P <0.01). CONCLUSIONS: Implementation of a guideline for diagnosis and treatment of venous leg ulcers resulted in improvement in diagnosis, decrease in healing time, and an increase in healing rates resulting in lower costs.

Wound treatment with human skin equivalent.

Skin grafting provides an effective means of closing chronic wounds. Autografts and allografts are used most often in skin grafting, but Apligraf, a tissue-engineered bilayered human skin equivalent, provides another safe and effective grafting option for treating diabetic, venous, and pressure ulcers. This skin equivalent has an epidermis and dermis similar to human skin, largely due to its derivation from neonatal foreskin. Apligraf is also easily accessible and has shown little immunoreactivity.