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Journal of Wound, Ostomy & Continence Nursing:
doi: 10.1097/WON.0b013e3182231850
WOUND CARE LITERATURE REVIEW: Review of the 2010 Evidence for WOC and Foot Care Nursing Practice

Wound Literature Review 2010

Collins, Patricia MSN, RN, ACNS-BC, CWOCN; CONTRIBUTOR; Falconio-West, Margaret BSN, RN, APN/CNS, CWOCN, DAPWCA; CONTRIBUTOR; Evans, Sharon MS, RN, CWOCN; CONTRIBUTOR

Section Editor(s): Doughty, Dorothy MN, RN, CWOCN, FAAN;

Free Access
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General Concepts in Wound Management

W1. Older Adults and Ulcers: Chronic Wounds in the Geriatric Population

Cheung C. Advances in Skin and Wound Care. 2010;23(1):39–43.

Article Type: Integrative review (CE)

Description/Results:

* Provides overview of common problems affecting prevalence and management of wounds in the elderly, including relationship between chronic pain and increased fall risk, and between falls and diabetic foot ulcers.

* Addresses medication issues unique to the elderly, such as the need to reduce warfarin dosage by 50% during antibiotic administration (especially trimethoprim/sulfamethoxazole).

* Provides table addressing dosing and adverse effects of analgesic medications.

What does this mean to me and my practice?

This is a helpful resource for clinicians managing wounds in geriatric patients, and especially for those who are prescribing meds or counseling patients re: meds.

W2. An evaluation of Cost and Effects of a Nutrition-Based Skin Care Program as a Component of Prevention of Skin Tears in an Extended Convalescent Center

Groom, M, Shannon R, Chakravarthy D, Fleck C. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):46–51.

Article Type: Research Study

Description/Results:

* Skin treatment with a nutrient-based skin care (NBSC) formulation was compared to a non–nutrient-based skin care (non-NBSC) formulation. The number of skin-tear-free days was the primary outcome measure.

* 100 residents were followed for 12 months, 6 months on each protocol. There was a statistically significant difference (P = 0.000) in the incidence of skin tears: 180 skin tears in 6 months with the non-NBSC formulation, as compared to 2 skin tears in 6 months with the NBSC formulation. The number of expected skin-tear-free days using NBSC was 179.7 days as compared to 154.8 days with non-NBSC days.

What does this mean for me and my practice?

These data suggest that NBSC, along with a comprehensive skin tear prevention program (staff education, proper positioning, protective clothing, and appropriate repositioning and transfer techniques), may significantly reduce the incidence of skin tears. (Note authors received financial support for manuscript development.)

W3. A Comparison of Collagenase to Hydrogel Dressings in Wound Debridement

Milne C, Coccarelli A, Lassy M. Wounds. 22(11):270–274.

Article Type: Research study

Description/Results:

* Phase I of a 2-phase trial evaluating time to complete wound debridement using collagenase or an amorphous hydrogel.

* Over 1 year, 27 participants of long-term care facilities with necrotic pressure ulcers were randomized to collagenase (n = 13) or hydrogel (n = 14). The same investigator performed the initial and weekly assessments. Participants remained in the study until day 42 or complete debridement.

* In the collagenase group, 85% achieved full debridement within the 42 days as compared to 29% of the hydrogel group (P < 0.002). A decrease in wound size occurred more quickly in the collagenase group (P < 0.009).

What does this mean to me and my practice?

In situations where conservative sharp debridement is not possible due to the limitations of the staff performing wound care, collagenase may provide more rapid debridement than plain hydrogel. Limitations of the study include small sample size and commercial sponsorship.

W4. The Effect of Various Wound Dressings on the Activity of Debriding Enzymes

Shi L, Ermis R, Kiedaisch B, Carson D. Advances in Skin and Wound Care. 2010;23(10):456–462.

Article Type: Research study

Description/Results:

* This in vitro study compared the effects of cadexomer iodine, nanocrystalline silver, and a foam dressing impregnated with methylene blue and gentian violet on the enzymatic activity of collagenase and of papain.

* Results: Cadexomer iodine almost totally inhibited the activity of collagenase, and nanocrystalline silver produced a 52% reduction in enzymatic activity, while the methylene blue/gentian violet dressing produced no inhibitory effects.

What does this mean to me and my practice?

This study provides further evidence that enzymatic agents and antimicrobial dressings should be used together only if there are data demonstrating compatibility.

W5. The Use of Dakin's Solution in Chronic Wounds

Corwell, P, Arnold-Long M, Bernahl Brass S, Varnado M. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):94–103.

Article Type: Case study/series

Description/Results:

* Provides review of literature related to the antimicrobial effect of various strengths of Dakin's solution.

* Includes review of five case studies demonstrating that dilute Dakin's solution can be effective in selected situations.

* Addresses factors that must be considered when contemplating the use of Dakin's: goals of treatment; dilution (concentration), frequency of dressing change; duration of treatment; protection of periwound skin; and patient condition and tolerance of treatment.

What does this mean for me and my practice?

These case studies provide limited data supporting the use of dilute Dakin's (eg, 0.0125%) for selected wounds (wounds in the inflammatory phase of repair that would benefit from removal of necrotic tissue and/or reduction in bacterial loads).

W6. Topical Cream or Inhaled Nitrous Oxide for Debridement Pain

Bolton L. Wounds. 22(8):A10–A11.

Article Type: Research study

Description/Results:

* Multicenter open-label RCT pilot study compared the analgesic efficacy of a topical cream and an inhaled short-term anesthetic agent with oxygen in 41 patients prior to debridement.

* Curette debridement of venous and/or arterial leg ulcers was preceded by the administration of nitrous oxide with oxygen (NOO) at 9–12 L/min for 3 minutes (n = 20) or topical application of up to 10 g of lidocaine-prilocaine (LP) cream covered with occlusive plastic film dressing for 30 minutes (n = 21).

* Pain postdebridement was lower for the LP cream group (P < 0.001). Requests to interrupt debridement due to pain was more frequent with NOO (P < 0.002).

What does this mean to me and my practice?

These data demonstrate the efficacy of LP cream in reducing pain associated with debridement.

W7. Validity of Diagnosis of Superficial Infection of Laparotomy Wounds Using Digital Photography: Inter- and Intra-observer Agreement Among Surgeons

Von Ramshorst G, Vrijland V, Van der Harst E, et al. Wounds. 22(2):38–43.

Article Type: Research study

Description/Results:

* In a prospective observational study involving abdominal surgical wounds, 4 GI surgeons independently assessed photos of 100 wounds; 50 of the wounds had been opened due to clinical indicators of infection. Surgeons were asked to determine presence or absence of infection based on CDC criteria for superficial SSI (surgical site infection). In addition to the photos, surgeons were provided information regarding current and previous day wound pain scores, morning temperature, and postop day.

* Surgeons agreed on treatment for 76 of the 100 wounds (conservative management versus surgical drainage), but agreed on the diagnosis of infection for only 12 of the wounds that had been previously opened due to apparent infection.

What does this mean to me and my practice?

This study provides additional evidence that digital photography is not a stand-alone assessment tool, and that accurate assessment and diagnosis must involve physical assessment and relevant clinical data.

W8. When and How to Perform a Biopsy on a Chronic Wound

Alavi A, Niakosari F, Sibbald G. Advances in Skin and Wound Care. 2010;23(3):132–139.

Article Type: Integrative review

Description/Results:

* Comprehensive review of wound biopsies, to include indications, considerations, selection of biopsy site (which is determined by reason for biopsy), supplies, technique for performing various types (shave, punch, and elliptical deep excisional biopsy), and processing guidelines.

What does this mean to me and my practice?

This review is geared primarily toward midlevel providers or MDs performing biopsies; it provides clear clinical guidance in regards to when and how to perform wound biopsies.

W9. Insights Into Acinetobacter War-Wound Infections, Biofilms, and Control

Dallo S, Weitao T. Advances in Skin and Wound Care. 2010;23(4):169–174.

Article Type: Integrative review

Description/Results:

* Provides summary of findings from recent studies regarding infected wounds among military personnel with Acinetobacter infections.

* Includes discussion of antibiotic resistance and an overview of the process and time frame for biofilm formation associated with Acinetobacter infections.

* Suggests that immunization may be used in the future to protect against pathogens such as Acinetobacter.

What does this mean to me and my practice?

Review provides further insight into the problems associated with biofilm development and management.

W10. A Cross-sectional Study to Validate Wound Care Algorithms for Use by Registered Nurses

Beitz JM, van Rijswijk L. Ostomy Wound Management. 2010;56(4):46–57.

Article Type: Research study

Description/Results:

* Goal of study was to evaluate the use of wound care algorithms by acute care nurses; algorithms had been previously validated by wound care nurses.

* Nurses using the algorithm made appropriate dressing decisions 75–91% of the time.

What does this mean to me and my practice?

Study demonstrates that clinically validated algorithms can promote appropriate wound care by clinicians who lack expertise in wound care.

W11. Hyperbaric Oxygen Therapy for Chronic Wounds

Hunter S, Langemo D, Anderson J, Hanson D, Thompson P. Advances in Skin and Wound Care. 2010;23(3):116–119.

Article Type: Integrative review

Description/Results:

* Presents prognostic indicators for successful use of HBOT: TcPO2 at wound edge of <40 mm Hg that increases by at least 10 mm Hg in response to 100% oxygen via mask; and TcPO2 >200 mm Hg after HBOT.

* Addresses contraindications and risks associated with HBOT.

* Provides current criteria for CMS reimbursement (diabetic ulcers Wagner grade 3 or higher that do not respond to 30 days of conservative therapy).

What does this mean to me and my practice?

This review provides updated guidelines for appropriate use of HBOT.

W12. Scale: Skin Changes at Life's End: Final Consensus Statement: October 1, 2009

Sibbald RG, Krasner D, Lutz J. Advances in Skin and Wound Care. 2010;23(5):225–238.

Article Type: Integrative review (CE)

Description/Results:

* Provides summary of recommendations generated by consensus panel convened to discuss skin changes at end of life (including Kennedy Terminal Ulcers).

* Recommendations emphasize the importance of thorough assessment of both skin status and patient's care goals, and development of an individualized management plan based on these data.

* Panel members also address lack of research regarding normal changes in skin and tissue status at end of life and identify specific research priorities.

What does this mean to me and my practice?

Concisely summarizes current guidelines for skin assessment and skin care for terminally ill patients.

W13. Chronic Wounds Treated With a Physiologically Relevant Concentration of Platelet-Rich Plasma Gel: A Prospective Case Series

Frykberg R, Driver V, Carman D, et al. Ostomy Wound Management. 2010;56(6):36–44.

Article Type: Case series

Description/Results:

* Series included 49 patients in several long-term acute care (LTAC) hospitals and outpatient clinics with 65 chronic wounds who were selected for treatment with PRP gel.

* Average wound duration was 47.8 weeks; article provides no discussion of previous treatment.

* 97% of patients showed progress toward healing as demonstrated by reduced area, volume, undermining, and sinus tracts/tunneling.

What does this mean to me and my practice?

Study results suggest that PRP gel may be a viable treatment option for chronic wounds that are poorly responsive to standard therapy. Findings are limited by the fact that this was a convenience sample with no control group.

W14. The Lived Experience of Diverse Elders With Chronic Wounds

Goldberg E, Beitz J. Ostomy Wound Management. 2010;56(11):36–46.

Article Type: Research study

Description/Results:

* Study was extension of previous study of 16 financially stable Caucasian elders; this study included 11 non-Caucasian elders with chronic wounds of >8 weeks' duration.

* Taped interviews and analyses were used to identify common themes in their lived experience: themes common to original group and this group included tolerating pain, limited mobility, and living with chronic illness.

* Concerns of this group that were different included cost considerations and impact on social roles; the previous group had identified distrust of caregivers and altered sleeping and eating habits.

What does this mean to me and my practice?

Provides helpful insight into potential concerns of various groups of elders with wounds.

W15. Diagnosis and Management of Foreign Bodies in the Skin

Winland-Brown J, Allen S. Advances in Skin and Wound Care. 2010;23(10):471–476.

Article Type: Integrative review (CE)

Description/Results:

* Provides review of assessment, diagnostic workup, and management of wounds associated with foreign bodies.

What does this mean to me and my practice?

Would be helpful for clinicians working in urgent care centers, emergency departments, and outpatient wound centers.

W16. A Prospective Comparison of Clinical Outcomes and Medicare Expenditures in Skilled Nursing Facility Residents With Chronic Wounds

DaVanzo J, El-Gamil A, Dobson A, Sen N. Ostomy Wound Management. 2010;56(9):44–54.

Article Type: Research study

Description/Results:

* Study involved 683 residents of long-term care facilities who had a chronic lower extremity wound documented by ICD-9 codes and the MDS.

* The study group included 372 residents, and the control group included 311 residents; groups were matched for severity of wounds, age, gender, diabetes, and other comorbidities. The study group was managed according to a comprehensive wound protocol under the direction of a consulting wound care specialist, and the control group was managed with usual care.

* Outcomes measures included wound-related hospitalizations and total cost of wound care to the point of closure.

* The study group had statistically fewer hospital days and days to healing. The total Medicare costs for the control group were almost double the costs for the study group ($21,449.64 vs $40,678.83).

What does this mean to me and my practice?

Provides support for the use of standardized guidelines for care and the role of wound care specialists.

Data from this study would be helpful to a wound care nurse who is trying to prove his/her value in objective terms.

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Nutrition

W17. Immunonutrition for High Risk Surgical Patients: A Systematic Review and Analysis of the Literature

Marik PE, Zaloga GP. Journal of Parenteral and Enteral Nutrition. 2010;34(4):378–386.

Article Type: Systematic review

Description/Results:

* Provides a summary analysis of 21 studies with a total of 1918 patients treated with Immunonutrition Modulating Diets (IMD) containing arginine and fish oil. Formulas studied included Impact, Stresson, arginine alone, and fish oil alone.

* Patients on IMDs had significantly reduced incidence of postoperative infections (P < .0001), wound complications (P < .02), and length of stay (P < .0001), but no reduction in mortality.

What does this mean to me and my practice?

This study provides evidence of the effect of nutrition on surgical wound healing, especially its effect on the immune system.

W18. Nutrition: A Critical Component of Wound Healing

Posthauer ME, Dorner B, Collins N. Advances in Skin and Wound Care. 2010;23(12):560–572.

Article Type: Integrative review (CE)

Description/Results:

* Provides comprehensive review of nutrition as related to wound healing.

* Specific information includes tools and guidelines for nutritional assessment; review of reasons why lab data cannot be utilized as “sole indicator” of nutritional status; indicators of specific vitamin and mineral deficiencies; and recommendations for dietary interventions.

* Includes summary of nutritional support recommendations from NPUAP Guidelines (30–35 cal/kg body weight per day, 1.25–1.5 g protein/kg body weight per day, and vitamin/mineral supplements if dietary intake poor and vitamin-mineral deficiencies suspected).

What does this mean to me and my practice?

Provides thorough review of current guidelines for nutritional assessment and management of patients with wounds.

W19. Sarcopenia, Cachexia, and Starvation

Collins N. Ostomy Wound Management. 2010;56(2):14–17.

Article Type: Integrative review

Description/Results:

* Article addresses three causes of weight loss: sarcopenia, cachexia, and starvation.

* Provides guidance for selection of nutritional interventions based on etiology of weight loss: food, nutritional supplements, vitamins, selected amino acids, appetite stimulants, and/or anabolic agents.

What does this mean to me and my practice?

Provides in-depth review of the various types/causes of weight loss, with implications for management. This review is particularly valuable for wound care providers who do not have ready access to a dietitian.

W20. Using Laboratory Data to Evaluate Nutritional Status

Collins N, Friedrich L. Ostomy Wound Management. 2010;56(3):14–16.

Article Type: Integrative review

Description/Results:

* Provides thorough review of the various lab studies typically used in evaluation of nutritional status: albumin, prealbumin, C-reactive protein, retinol binding protein, transferrin, total lymphocyte count, and cholesterol.

* Addresses factors other than nutritional status that affect values and focuses attention on the fact that laboratory values should not be used as sole indicators of nutritional status.

What does this mean to me and my practice?

Provides clear explanations of factors affecting commonly used lab values, such as prealbumin, and implications for practice: laboratory values are only one element of a comprehensive nutritional assessment and cannot function as sole indicators.

W21. Dealing With Patients Who Disregard Nutritional Advice

Collins N. Ostomy Wound Management. 2010;56(6):16–20.

Article Type: Integrative review

Description/Results:

* Discusses concepts and types of nutritional nonadherence: nonadherence related to demographic characteristics, psychological variables, and social variables.

* Includes table of “tips” for dealing with patients who are nonadherent to nutritional advice.

What does this mean to me and my practice?

Provides very practical guidance to wound care nurses in assessing and assisting patients who are initially nonadherent to the nutritional treatment plan.

W22. Nutrition Advice for Patients Living at Home

Collins N. Ostomy Wound Management. 2010;56(10):18–21.

Article Type: Integrative review

Description/Results:

* Provides overview of nutritional needs of wound patients in the home setting, where there is typically lack of or very limited nutritional education.

* Provides practical tips for boosting calorie and protein intake and for managing blood glucose and kidney health.

* Includes extensive list of “healthy snacks” provided as a helpful alternative to nonspecific advice to “eat healthy” or “increase your protein.”

What does this mean to me and my practice?

Provides guidelines that could be used by wound care nurse to provide meaningful and practical patient education, especially in situations when a registered dietitian is not readily available.

W23. The Physical Assessment Revisited: Inclusion of the Nutrition-Focused Physical Exam

Collins N, Harris C. Ostomy Wound Management. 2010;56(11):25–29.

Article Type: Integrative review

Description/Results:

* Discusses the fact that lab studies such as albumin and prealbumin may not be the best indicators of nutritional status, since these values are significantly impacted by other factors, such as inflammation.

* Includes review of factors to be included in a comprehensive nutritional evaluation, such as height and weight, recent weight changes, and physical findings (status of skin and oral cavity, head and neck, abdomen, bones, and joints).

What does this mean to me and my practice?

Provides additional information regarding limitations of albumin and prealbumin in nutritional evaluation, and other factors that need to be included in nutritional assessment.

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Pressure Ulcers

W24. Clarification From the ANA on the Nurse's Role in Pressure Ulcer Staging

Lyder C, Krasner D, Ayello E. Adv Skin Wound Care. 2010;23(1):8–10.

Article Type: Regulatory update

Description/Results:

* In response to establishment of ICD-9 (diagnosis) codes for various pressure ulcer stages, there have been numerous questions as to whether or not nurses can classify wounds as pressure ulcers and stage them. The authors therefore wrote a letter to ANA Board of Directors, posing this question.

* ANA responded that skin assessment including identification and staging of pressure ulcers is within the nursing scope of practice, if the nurse has the educational preparation and experience to carry out this level of differential assessment.

* ANA also noted that WOC nurses are the experts.

* ANA Board of Directors further stated that this does not take the place of the physician's documentation of pressure ulcer stage.

What does this mean to me and my practice?

Provides support for role of wound care nurse in differential assessment and staging of pressure ulcers.

W25. An Overview of the Tissue Types in Pressure Ulcers: A Consensus Panel Recommendation

Black J, Baharestani M, Black S, et al. Ostomy Wound Management. 2010;56(4):28–42.

Article Type: Integrative review

Description/Results:

* Goal of consensus panel was to develop a common language with anatomically accurate and practical terms that can be used to describe and stage pressure ulcers. The goal is to implement this terminology in all care settings.

* Provides description of all pressure ulcer stages and types of tissue associated with wounds.

What does this mean to me and my practice?

Provides current guidelines for staging and for description of wound status; promotes standardization of wound-related terms. This would be a beneficial resource for a wound care nurse when in-servicing staff and new orientees regarding wound assessment.

W26. Friction and Shear Considerations in Pressure Ulcer Development

Hanson D, Langemo D, Anderson J, Thompson P, Hunter S. Advances in Skin and Wound Care. 2010;23(1):21–24.

Article Type: Integrative review

Description/Results:

* Provides review of current information regarding relationships between friction, shear, and pressure. Friction is described as “resistance to motion in a parallel direction” that can cause surface abrasions; authors state that friction can contribute to pressure ulcers by reducing the amount of pressure needed to create an ulcer, and can also contribute to shear damage by causing the superficial skin layers to adhere to the linens while the deeper tissue layers move downward.

* Includes discussion of mechanisms by which shear force causes ischemic injury (by causing tissue distortion) and discusses implications for practice, including a review of studies indicating that dressings with a low-friction outer layer can reduce shear force.

What does this mean to me and my practice?

Provides definitions and clarification of roles played by friction and shear in development of superficial and deep tissue injuries. Includes a review of data suggesting that clinicians can reduce shear force through selection of dressings with a low-friction outer surface.

W27. Heel Ulcer Incidence Following Orthopedic Surgery: A Prospective, Observational Study

Campbell K, Woodbury M, Labate T, LeMesurier A, Houghton P. Ostomy Wound Management. 2010;56(8):32–39.

Article Type: Research study

Description/Results:

* Incidence of heel ulcers in orthopedic patients is reported as being as high as 17%. In this study 72 patients were followed from acute care through rehab or home health.

* 12 of the 72 patients developed ulcers; all ulcers developed in the acute care setting. 42% of the wounds were Stage II, 33% were sDTI, 16% were Stage 1, and 8% were unstageable.

What does this mean to me and my practice?

Provides clear evidence that prevention of pressure ulcers in the orthopedic population must begin in the acute care setting, with a focus on prevention through offloading (heel elevation) and close monitoring/early detection.

W28. Pressure Ulcers in Individuals Receiving Palliative Care: A National Pressure Ulcer Advisory Panel White Paper

Langemo D, Black J; National Pressure Ulcer Advisory Panel. Advances in Skin and Wound Care. 2010;23(2):59–72.

Article Type: Integrative review

Description/Results:

* Comprehensive review of the current literature related to prevention and management of pressure ulcers in palliative care setting, with levels of evidence for each recommendation.

* Major topics include risk assessment, prevention measures (pressure reducing surfaces, turning and positioning, nutrition and hydration, and skin care), goal-setting related to skin and wound care, and guidelines for wound management (pain management, control of infection and odor, indications for debridement, exudate management, and dressing selection).

* Includes discussion of concept of skin failure.

What does this mean to me and my practice?

This would be a valuable resource for anyone developing policies, procedures, or care guidelines for prevention and management of pressure ulcers in the palliative care population.

W29. The Demographics of Suspected Deep Tissue Injury in the US: An Analysis of the International Pressure Ulcer Prevalence Survey 2006–2009

VanGilder C, MacFarlane G, Harrison P, Lachenbruch C, Meyer S. Advances in Skin and Wound Care. 2010;23(6):254–261.

Article Type: Research study

Description/Results:

* Provides a summary of findings from Hill Rom's P&I studies from 2006–2009, with particular attention to the percentage of ulcers classified as sDTI (suspected deep tissue injury), and characteristics of patients with sDTI as compared to those with ulcers of different stages.

* Authors relate characteristics of patients with sDTI to a theory advanced by Gefen that sDTI formation is more likely in patients and anatomical sites characterized by angular bony prominences and inadequate tissue padding.

* In this report sDTIs represented 9% of all ulcers and 41% occurred on the heels (19% on the sacrum and 13% on the buttocks). Extreme obesity was associated with a lower incidence of sDTIs.

* The authors point out that these data appear to support Gefen's hypothesis, though further study is needed.

What does this mean to me and my practice?

These data reinforce the importance of heel elevation and attention to sites with limited fat padding in pressure ulcer prevention and suggest that these sites may be at greater risk for sDTI formation.

W30. Pressure Ulcer Prevention in Long-term Care Facilities: A Pilot Study Implementing Standardized Nurse Aide Documentation and Feedback Reports

Horn S, Sharkey S, Hudak S, Gassaway J, James R, Spector W. Advances in Skin and Wound Care. 2010;23(3):120–131.

Article Type: Research study

Description/Results:

* Summarizes results of pilot trial to determine effects of increased involvement of CNAs in tracking, documenting, and reporting on resident factors affecting risk for pressure ulcer development in LTC.

* Multicenter initiative involved development of one simple form for tracking resident's weight, nutritional intake, hygienic care, skin status, bowel and bladder management, mobility, and negative behaviors; these data were used to generate reports that identified early changes in resident status that increased their risk of pressure ulcer development.

* CNAs were active participants in the study.

* Pressure ulcer incidence decreased by 62%. Authors conclude that this approach is feasible and that centralizing reports on resident status and empowering CNAs are critical success factors, as is DON involvement.

What does this mean to me and my practice?

Provides specific guidelines for increasing staff awareness of changes in resident status and using this enhanced awareness to adjust the care plan in a timely manner. This study also provides objective data that CNAs play a critical role in pressure ulcer prevention.

W31. Factors Associated With Pressure Ulcers in Patients in a Surgical Intensive Care Unit

Slowikowski G, Funk M. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):619–626.

Article Type: Research study

Description/Results:

* Study was designed to identify factors associated with the development of pressure ulcers in an intensive care unit (ICU) population as a first step in the development of a pressure ulcer risk assessment tool for this population (Surgical ICU Pressure Ulcer Risk Assessment Scale, SUPRA).

* In Phase 1, investigators utilized literature review to identify comorbidities associated with PrUs in the critical care setting, and constructed the initial scale based upon this review; they then conducted a chart review of 230 ICU patients with hospital acquired pressure ulcers and modified the initial scale based upon this review.

* In Phase 2, investigators used the modified scale to assess risk in 139 additional patients.

* Results: In this ICU population, age >70 and diabetes were found to be additional relevant risk factors (in addition to a low Braden Score).

What does this mean to me and my practice?

Data from this study suggest that age and diabetes may represent risk factors for pressure ulcer development in ICU patients (in addition to low Braden Scale); however, further study is needed.

Study limitations included convenience sample, one care setting, incomplete data on selected variables, and definition of inadequate nutrition limited to present nutritional intake.

W32. WOCN Update on Evidence-Based Guidelines for Pressure Ulcers

Ratliff C, Tomaselli N; Guidelines Task Force. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):459–460.

Article Type: Integrative review

Description/Results:

* Provides brief summary of revised Guidelines for Pressure Ulcer Prevention and Management (published 2010 by JWOCN).

* Guidelines provide specific recommendations with levels of evidence for prevention, assessment, and treatment of pressure ulcers.

What does this mean to me and my practice?

Provides synopsis of current guidelines for prevention and management of pressure ulcers; beneficial in reviewing practice and in referencing guidelines for prevention and management of pressure ulcers.

W33. Vibration Therapy Accelerates Healing of Stage I Pressure Ulcers in Older Adult Patients

Arashi M, Sugama J, Sanada H, et al. Advances in Skin and Wound Care. 2010;23(7):321–327.

Article Type: Research study

Description/Results:

* Study based on hypothesis that vibration therapy would improve microcirculation and thereby promote healing of stage I pressure ulcers. Controlled vibration was applied to the ulcer site for 15 minutes 3 times daily till healing occurred or a maximum of 7 days. Investigators used hand-held spectrometer as opposed to visual inspection to determine intensity of erythema.

* 40% of the experimental group healed as compared to 9.5% of the control group (P = 0.033); 4 ulcers in the experimental group deteriorated, and 8 in the control group deteriorated.

* Authors report results of a previous study which showed a significantly lower skin temperature in Stage I ulcers that deteriorated as compared to those that healed.

What does this mean to me and my practice?

This study provides preliminary data suggesting that vibration therapy may promote healing of Stage I ulcers by enhancing microcirculation; further study is needed before recommendations can be made.

W34. Poor Nutrition Is a Relative Contraindication to Negative Pressure Wound Therapy for Pressure Ulcers: Preliminary Observations in Patients With Spinal Cord Injury

Ho C, Powell H, Collins J, Bauman W, Spungen A. Advances in Skin and Wound Care. 2010;23(11):508–516.

Article Type: Research study

Description/Results:

* Study involved comparison of healing rates in patients with Stage III or Stage IV pressure ulcers managed with standard therapy (53) versus those managed with NPWT (33); all patients received standard care (pressure reducing surfaces, etc), and the study period was 28 days. The decision to add NPWT was made at the discretion of the managing physician.

* There was no significant difference in healing rates between patients managed with NPWT and those managed with standard therapy. Within the NPWT group, patients who failed to respond positively had lower albumin rates than those who did respond.

* As a result, investigators suggest that NPWT may be less effective and less appropriate among patients with low albumin levels.

What does this mean to me and my practice?

This study points out that we have limited controlled trials to prove the benefits of NPWT and also highlights the fact that other factors (such as nutritional status) may be important predictors of response to advanced wound therapies. Limitations of the study include use of albumin as the sole indicator of nutritional status, the lack of random assignment to NPWT versus standard care, and the failure to include depth or reduction in tunneled/undermined areas in the assessment of healing. (Healing rates were determined simply by wound surface area, i.e., length ÷ width.)

W35. A Prospective Evaluation of a Pressure Ulcer Prevention and Management e-Learning Program for Adults With Spinal Cord Injury

Brace J, Schubart J. Ostomy Wound Management. 2010;56(8):40–50.

Article Type: Research study

Description/Results:

* The reported pressure ulcer incidence rate among cord-injured patients is close to 85%, which suggests a need for further education.

* Study was designed to evaluate efficacy of an e-learning program (video on pressure ulcer prevention) for patient education, using pre-test post-test design.

* Average scores on pretest were 65 as compared to 92.5 on post-test.

What does this mean to me and my practice?

Study findings suggest that e-learning programs can be utilized effectively for patient education; however, this study addressed only a change in knowledge level among patients immediately following participation in an e-learning module, and did not involve education of caregivers nor any follow-up on incidence rates. Further study is needed before any recommendations can be made.

W36. Health-Related Quality of Life and Depression in Older Patients With Pressure Ulcers

Galhardo V, Magalhaes M, Blanes L, Juliano Y, Ferreira L. Wounds. 2010;22(1):20–28.

Article Type: Research study

Description/Results:

* Study compared HRQoL scores in patients with and without pressure ulcers.

* Sample included 42 outpatients in Brazil; all were 60 years or older, had no significant cognitive deficit, lived at home and received health care at the local clinic. Fifty percent of the 21 patients with pressure ulcers had Stage II ulcers, 44.5% were in the sacral area, and 80.9% were hospital acquired.

* Patients with PU had significantly lower HRQol scores (P < 0.0001).

What does this mean to me and my practice?

This study provides further data regarding the impact of pressure ulcers on quality of life and the importance of preventive measures.

W37. Results of a Clinician-Led Evidence Based Task Force Initiative Relating to Pressure Ulcer Risk Assessment and Prevention

Young J, Ernsting M, Kehoe A, Holmes K. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):495–503.

Article Type: Quality improvement report

Description/Results:

* Clinician-led task force was created to identify and apply current evidence to clinical practice in the areas of risk assessment and pressure ulcer prevention in the acute care.

* Identified key groups to be included in process improvement (nursing leadership, clinical governance, clinical leaders).

* Critical elements in process improvement included review and modification of support surfaces and skin/wound care products, revision of policies and procedures, updates to the electronic documentation system, and intensive staff education.

* Results: All campuses reported marked reduction in hospital-acquired pressure ulcers.

What does this mean for me and my practice?

This report demonstrates that a comprehensive program based on analysis of current practice and a focus on areas of deficiency can significantly reduce facility-acquired pressure ulcers.

W38. Pressure Ulcer Risk in Ancillary Services Patients

Messer MS. Journal of Wound, Ostomy and Continence Nursing. 2010;37(2):153–158.

Article Type: Systematic review (CE)

Description/Results:

* Review involved 43 studies that met established criteria.

* Review focused on two factors contributing to pressure ulcer development during ancillary service procedures: pressure and shear forces, and factors affecting tissue tolerance.

* Results: Data suggested the following as contributing factors to pressure ulcer development: high interface pressure on ancillary services' support surfaces; shear incurred during patient movement and positioning; advanced age; severe neurologic impairment; anesthesia and sedation; fever/sepsis; hypotension.

* The ability to reach valid conclusions was limited by the following: small sample sizes; inconsistent control of variables; and absence of appropriate statistical analysis.

What does this mean for me and my practice?

Provides limited data suggesting that pressure ulcers can begin during the time the patient is off the nursing unit for diagnostic and interventional procedures, and provides further support for facility-wide approach to pressure ulcer prevention.

W39. Stop Them at the Door: Should a Pressure Ulcer Prevention Protocol Be Implemented in the Emergency Department?

Denby A, Rowlands A. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):35–38.

Article Type: Research study

Description/Results:

* Study was conducted to examine the relationship between ED length of stay and hospital-acquired pressure ulcers for patients in a small community hospital.

* Data were obtained through retrospective chart review.

* Results: 75% of the patients seen in the ED were admitted. 99.2% of the 125 patients who developed a pressure ulcer had an ED length of stay >2 hours. 61.6% were Stage I and 38.4% were Stage II; the majority were on the sacrum, coccyx, and heels.

What does this mean for me and my practice?

Results suggest that pressure ulcer prevention should be implemented in the ED. Limitations of the study include small sample size and one clinical site

W40. The Association of BMI and Braden Total Score on the Occurrence of Pressure Ulcers

Drake D, Swanson M, Baker G, et al. Journal of Wound, Ostomy and Continence Nursing. 2010;37(4):367–371.

Article Type: Research study

Description/Results:

* Compared PrU prevalence among patients with a BMI >40, and Braden Scale scores of ≤16 to patients with lower BMI.

* Results: Prevalence among patients with a BMI < 40 was 12.5% as compared to 26% in patients with a BMI > 40. BMI of > 40 and Braden Scale of ≤16 were found to have an independent and statistically significant association with PrU occurrence.

What does this mean for me and my practice?

This study provides important data for wound nurses caring for bariatric patients; results suggest that bariatric patients are at increased risk for pressure ulcer development, especially if they also have additional risk factors per Braden Scale.

W41. Preventing Heel Pressure Ulcers and Plantar Flexion Contractures in High-Risk Sedated Patients

Meyers T. Journal of Wound, Ostomy and Continence Nursing. 2010;37(4):372–378.

Article Type: Research study

Description/Results:

* 53 sedated patients in an ICU for ≥5 days with a Braden Scale of 16 or less were treated with heel protector devices that maintained the foot in a neutral position and floated the heel off of the bed. Devices were removed every shift to assess the heel and to provide daily passive range of motion.

* There were no heel pressure ulcers or plantar flexion contractures among the study group.

What does this mean for me and my practice?

Provides objective data supporting the impact of heel elevation devices in prevention of heel ulcers, and provides limited support for use of devices that maintain neutral foot position as part of an overall program for prevention of plantar flexion contractures.

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Lower Extremity Ulcers

W42. Lipedema: A Frequently Misdiagnosed and Misunderstood Fatty Deposition Syndrome

Fife C, Maus E, Carter M. Advances in Skin and Wound Care. 2010;23(2):81–92.

Article Type: Integrative review (CE)

Description/Results:

* Provides comprehensive review of lipedema as compared to other edema syndromes.

* Includes discussion of pathology, clinical presentation, psychological effects, potential for progression to lipolymphedema, differential diagnosis, and management.

* Provides excellent color illustrations.

What does this mean to me and my practice?

Valuable synopsis for wound care nurses who care for patients with complex edema syndromes.

W43. Topical Wound Oxygen Therapy in the Treatment of Severe Diabetic Foot Ulcers: A Prospective Controlled Study

Blackman E, Moore C, Hyatt J, Railton R, Frye C. Ostomy Wound Management. 2010;56(6):24–31.

Article Type: Research study

Description/Results:

* Study was designed to evaluate use of pressurized topical oxygen therapy (TWO2) in patients with diabetic foot ulcers and to assess recurrence rates over 24 months.

* Treatment group had significantly larger wounds at baseline (4.1 vs 1.4 cm2) and also had wounds of greater duration (6.1 vs 3.2 months, not statistically significant). All had plantar surface wounds penetrating to capsule or bone or deeper.

* Control group managed with silver alginate dressing and treatment group managed with daily saline moist gauze dressings and TWO2 for 60 minutes daily ÷ 5 days. The groups were equally debrided and offloaded, and were similar in age, gender, A1c levels, and ABI.

* Results: Treatment group: complete healing (full epithelialization without drainage) in 14 of 17 patients versus 5 of 11 patients in the control group. Median closure time was 56 days vs 93 days for the control group. There was no recurrence in either group at 24 months.

What does this mean to me and my practice?

While topical oxygen has not previously been thought to be of benefit, study results suggest that further research is warranted. Study limitations include the fact that it was neither randomized nor blinded.

W44. A Prospective, Multicenter Study to Validate Use of the Pressure Ulcer Scale for Healing (PUSH©) in Patients With Diabetic, Venous, and Pressure Ulcers

Hon J, Lagden K, McLaren A, et al. Ostomy Wound Management. 2010;56(2):26–36.

Article Type: Research study

Description/Results:

* Study investigated whether the PUSH Tool (3.0) could be valid for use with venous and diabetic wounds as well as pressure ulcers (Stages II, III, and IV).

* PUSH tool was originally designed by the NPUAP as a tool to describe healing of pressure ulcers and to prevent reverse staging. Scores are based on 3 parameters: wound surface area, exudate amount, and tissue type.

* 98 wounds were evaluated using the PUSH Tool; measurements were taken at baseline and 4 weeks.

* Results indicated that the PUSH Tool is valid and responsive to change in all 3 types of wounds studied, with statistical significance (P = .000).

What does this mean to me and my practice?

Provides objective data supporting use of PUSH Tool for evaluation of diabetic and venous wounds as well as pressure ulcers.

W45. Hyperbaric Oxygen Therapy as an Adjunctive Treatment for Diabetic Foot Wounds: A Comprehensive Review With Case Studies

Daly M, Fault J, Steinberg J. Wounds. 2010;22(1):1–11.

Article Type: Systematic review

Description/Results:

* Reviews findings from Cochrane Collaboration's systematic review of 26 studies addressing impact of HBOT on wound healing.

* Focuses on 4 studies that specifically addressed the effects of HBOT on nonhealing diabetic foot wounds

* Inconsistencies in these 4 studies prevented any valid conclusions.

What does this mean to me and my practice?

Provides valuable information for any wound care nurse managing patients with diabetes and nonhealing wounds, and reminds clinicians that there is limited evidence to support use of HBOT and that this therapy must be used judiciously and only as an adjunct to comprehensive wound care.

W46. Combining Acoustic Pressure Wound Therapy With Electrical Stimulation for Treatment of Chronic Lower-Extremity Ulcers: A Case Series

Lasko J, Kochik J, Serena T. Advances in Skin and Wound Care. 2010;23(10):446–449.

Article Type: Case series

Description/Results:

* Series involves 10 patients with nonhealing lower-extremity wounds who were managed with a combination of acoustic pressure wound therapy and electrical stimulation; the use of this combination was based on the authors' personal observations that the combined therapies seemed to produce better results than either therapy alone.

* Data was collected retrospectively from medical records.

* Results: Ulcers had been managed with conventional moist wound healing and had been nonhealing for 7–85 weeks (mean 30.7 weeks); following the addition of the combined acoustic pressure wound therapy and electrical stimulation, wounds closed in 8–36 weeks (mean, 17.6 weeks).

What does this mean to me and my practice?

Authors acknowledge that this was not a controlled trial and patients were not randomly assigned to receive the chosen therapies but point out that such combination therapies may have the potential to promote healing of recalcitrant wounds and may warrant further study. Data provide further evidence that refractory wounds frequently respond to adjunctive therapies chosen by a knowledgeable clinician.

W47. Are Toe Pressures Measured by a Portable Photophlethysmograph Equivalent to Standard Laboratory Tests?

Bonham P, Kelechi T, Robinson J. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):475–486.

Article Type: Research study

Description/Results:

* The purpose was to determine if toe pressures (TPs) obtained by a registered nurse using a portable photophlethysmograph (PPG) were equivalent to TPs obtained by a registered vascular technologist (RVT) using standard laboratory equipment.

* Sample was comprised of 30 subjects who had been referred to a vascular laboratory for arterial studies.

* The TPs obtained by portable PPG were not equivalent to those obtained in the vascular lab for the group as a whole; however, the portable PPG did demonstrate good sensitivity (79%) and high specificity (95%) for detection of LEAD.

What does this mean for me and my practice?

Data from this study indicate that portable PPG performed by a trained clinician may be used in selected situations as a screening tool for LEAD.

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Burns, Skin Cancers, and Atypical Wounds

W48. Hidradenitis Suppurativa: A Clinician's Tool for Early Diagnosis and Treatment

Beshara M. Advances in Skin and Wound Care. 2010;23(7):328–332.

Article Type: Integrative review

Description/Results:

* Provides a comprehensive review of the prevalence, pathology, risk factors, clinical presentation, and management of hidradenitis suppurativa.

* Includes discussion of updated theories regarding pathology (occlusive disease of apocrine glands versus disorder of follicular occlusion).

* Addresses all treatment options, both conservative measures such as antimicrobial dressings, and pharmacologic and surgical options (infliximab and other tumor necrosis factor (TNF) blockers, and radical excision).

What does this mean to me and my practice?

Beneficial review for any wound care nurse who provides care or consultation to patients with HS.

W49. Palliative Surgery for Advanced Fungating Skin Cancers

Fujioka M, Yakabe A. Wounds. 2010;22(10):247–255.

Article Type: Case study/series

Description/Results:

* Reports on 2 patients with fungating tumors, one with breast cancer and the other with amelanotic malignant melanoma of the skin.

* Palliative surgery was performed to remove the tumors followed by skin grafting.

* While each patient later died of metastases, the quality of their lives improved to the point that they were able to return home.

What does this mean to me and my practice?

Provides support for comprehensive palliative care, including surgery when indicated.

W50. Local Wound Care for Malignant and Palliative Wounds

Woo K, Sibbald RG. Advances in Skin and Wound Care. 2010;23(9):417–428.

Article Type: Integrative review

Description/Results:

* Addresses care priorities and options for management of malignant and other nonhealing wounds.

* Provides specific guidance for control of bleeding, odor, pain, exudate, and bacteria.

* Includes a table of antiseptic agents, antimicrobial dressings, and topical antibiotics.

What does this mean to me and my practice?

Helpful resource for wound nurses who manage patients with fungating tumors and other nonhealing wounds.

W51. Treatment of the Burn Patient in Primary Care

Moss L. Advances in Skin and Wound Care. 2010;23(11):517–524.

Article Type: Integrative review (CE)

Description/Results:

* Provides comprehensive guidelines for management of burn wounds in the primary care setting.

* Includes indications for referral to a burn center, initial management of wounds based on depth (superficial, partial-thickness, and full-thickness), and the differing opinions and rationale on management of blisters.

* Provides guidance for management of long-term issues, such as itching and prevention of contractures.

What does this mean to me and my practice?

Would be helpful for any clinician who is providing burn care and making decisions regarding referral to a burn center.

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Legal/Regulatory Issues

W52. Legal Issues in the Care of Pressure Ulcer Patients: Key Concepts for Healthcare Providers—Consensus Paper From the International Expert Wound Care Advisory Panel

Fife C, Yankowsky K, Ayello E, et al. Advances in Skin and Wound Care. 2010;23(11):493–507.

Article Type: Integrative review

Description/Results:

* Provides a comprehensive review of current legal issues related to facility-acquired pressure ulcers, with very specific implications and guidelines for practitioners.

* Includes discussion of strategies to minimize risk of litigation: verbiage to avoid when writing/updating policies and procedures; critical information to be included in documentation of both preventive care and wound care; importance of appropriate communications with the patient and family regarding pressure ulcer risk, preventive care, and factors leading to breakdown.

* Addresses what to do and what to avoid if you are involved in litigation.

What does this mean to me and my practice?

This is an excellent review of legal issues for all practitioners involved in wound care.

W53. Overview: 2010 Final Rule for Hospital-Owned Outpatient Wound Care Departments

Schaum K. Advances in Skin and Wound Care. 2010;23(1):17–20.

Article Type: Regulatory update

* Provides updated guidance for physician supervision in hospital-based outpatient clinics.

* Addresses revised regulations that now permit advanced practice nurses, clinical nurse specialists, and physician assistants to provide supervision for outpatient wound care, so long as the services they are supervising are services that they are covered to perform.

* Summarizes expectations related to availability of supervising clinician (does not have to be in room but has to be readily available to step in if needed).

* Includes review of guidelines for determining level of clinic visit (development of mapping system and policy and procedure explaining how to use mapping system).

What does this mean to me and my practice?

This provides essential information regarding regulatory guidelines affecting reimbursement for outpatient wound care services.

W54. When Should Nurse Practitioners Bill “Incident to” a Physician?

Schaum K. Advances in Skin and Wound Care. 2010;23(4):158–160.

Article Type: Regulatory update

Description/Results:

* Provides definition of “incident to” billing, practitioners who can bill “incident to,” and conditions that must be met for Medicare to pay for “incident to” services.

* Explains differences in payment when the NP bills using her/his own provider number.

What does this mean to me and my practice?

This is essential information for NPs who are working with physicians and using “incident to” billing; includes guidelines needed to assure compliance with current billing guidelines.

W55. Essentials of MDS 3.0 Section M: Skin Conditions*

Levine J, Roberson S, Ayello E. Advances in Skin and Wound Care. 2010;23(6):273–283.

Article Type: Regulatory update

Description/Results:

* Provides a thorough review of the revised MDS 3.0 assessment tool, which is used to gather and report data in the long-term care setting.

* Specifically addresses major changes in the 3.0 version: pressure ulcer risk assessment; modification in staging guidelines to enhance consistency with current NPUAP staging system; differences in staging of sDTI lesions and blood-filled blisters (sDTI is classified as unstageable and blood-filled blisters are classified as Stage II ulcers); delineation between ulcers POA (present on admission) and those that are facility-acquired; and elimination of reverse staging.

* Includes discussion of implications for the practitioner and emphasizes the importance of narrative documentation.

What does this mean to me and my practice?

This is an essential update for any WOC nurse or wound care nurse who works or provides consults in the long-term care setting.

W56. CMS Updates on MDS 3.0 Section M: Skin Conditions—Change in Coding of Blister Pressure Ulcers

Ayello E, Levine J, Roberson S. Advances in Skin and Wound Care. 2010;23(9):394–397.

Article Type: Regulatory update

Description/Results:

* Discusses specific changes: when staging blisters related to pressure the clinician must use assessment of the surrounding skin/tissue to determine whether or not there is evidence of an sDTI; if so, the wound should be classified as “unstageable.” If not, the wound should be classified as Stage II.

* The type of fluid in the lesion is not to be considered the definitive factor in LTC.

What does this mean to me and my practice?

Provides information that is essential for WOC nurse or wound care nurse providing consultation in the long-term care setting.

W57. Medicare Clarified Support Surface Policies and Coverage Requirements

Schaum K. Advances in Skin and Wound Care. 2010;23(7):300–304.

Article Type: Regulatory update

Description/Results:

* Provides a comprehensive review of current guidelines for CMS coverage of support surfaces in home care patients.

* Includes criteria and documentation requirements for Group 1, Group 2, and Group 3 surfaces, and types of surfaces included in each group.

What does this mean to me and my practice?

This article would be beneficial to any wound care nurse who is making recommendations for support surfaces in homebound patients.

W58. Can Physicians Use Selective Debridement Codes, 97597 and 97598, to Bill Medicare?

Schaum K. Advances in Skin and Wound Care. 2010;23(10):443–445.

Article Type: Regulatory update

Description/Results:

* Provides a concise review of current guidelines for billing wound debridement procedures.

* Includes explanation of providers who should use codes 11040–11044 (MDs and midlevel providers).

* Explains appropriate use of codes 97597 and 97598 by wound care nurses in hospital-based outpatient wound clinics.

* Includes explanation of claim denials and pathway for resolving claim denials.

What does this mean to me and my practice?

This is helpful information for wound care nurses in outpatient clinics who need to know which codes to use to bill for debridement.

W59. Certification Does Not Always Equal Separate Medicare Payment

Schaum K. Advances in Skin and Wound Care. 2010;23(11):489–492.

Article Type: Regulatory update

Description/Results:

* Provides current information related to billing for WOC nurse services, with helpful delineation between care settings and between specialty nurse services (CWOCN) and advanced practice services (APN).

* Provides clear explanations as to why CWOCNs who are not licensed as APNs cannot bill for services/obtain direct Medicare reimbursement in the acute care, home health, or long-term care setting.

* Provides guidelines for “incident to” billing in hospital-based outpatient departments or physician offices.

What does this mean to me and my practice?

This provides clear explanations of billing issues related to wound care nurse services; would be helpful to any nurse dealing with these questions.

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International Perspectives

W60. Iranian Diabetic Foot Research Network

Malazy O, Mohajeri-Tehrani M, Pajouhi M, Fard A, Amini M, Larijani B. Advances in Skin and Wound Care. 2010;23(10): 450–454.

Article Type: Integrative review

Description/Results:

* Describes a national initiative designed to promote evidence-based practice, standardized care algorithms, increased research, and enhanced clinician and patient education in the area of diabetic foot management and amputation prevention.

* Results: The initiative has sponsored 9 RCTs (including studies on an herbal agent that has significantly reduced the size of neuropathic ulcers); developed and disseminated evidence-based treatment guidelines; established multidisciplinary clinics in 7 provincial capitals; and implemented educational programs for both clinicians and patients.

* Amputation rates for patients with DFUs in two major referral centers have declined from 40% to 14%.

What does this mean to me and my practice?

Provides objective evidence that comprehensive programs to promote evidence-based diabetic foot care can effectively reduce amputation rates.

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Professional Practice

W61. Evidence-Based Medicine: An Overview of Key Concepts

Carter MJ. Ostomy Wound Management. 2010;56(4):68–85.

Article Type: Integrative review

Description/Results:

* Summarizes principles underlying evidence-based medicine (EBM).

* Provides evaluation of tools and resources used to promote and evaluate evidence-based practice.

* Includes explanation of concepts and terms commonly used in the literature related to evidence-based practice.

* Addresses importance of patient choice and clinical judgment in providing EBM.

What does this mean to me and my practice?

This is a valuable review for any clinician committed to providing evidence-based care.

W62. Cost-effectiveness Research in Wound Care: Definitions, Approaches, and Limitations

Carter MJ. Ostomy Wound Management. 2010;56(11):48–59.

Article Type: Integrative review

Description/Results:

* Addresses concepts related to cost-effective wound care, such as cost-benefit analysis, comparative effectiveness, and cost minimization.

* Provides guidance to clinician in evaluating a new wound care product in terms of both clinical effectiveness and cost impact.

What does this mean to me and my practice?

This is helpful information for any clinician who is responsible for evaluating products for inclusion in product formulary or clinical guidelines.

W63. Off-label Use of Prescription Medications: A Literature Review

Smith R. Wounds. 2010;22(4):79–86.

Article Type: Integrative review

Description/Results:

* Provides review of literature related to the off-label use of selected drugs in wound healing.

* Summarizes issues related to off-label use of pharmaceuticals: importance of evidence to support use; role of clinical judgment; FDA and Medicare positions on off-label use; importance of informed consent when products/medications used “off label.”

What does this mean to me and my practice?

This is very helpful information for any clinician who encounters off-label use of pharmaceuticals; includes accepted guidelines for assuring appropriate off-label use of any agent.

W64. Enterostomal Therapy Nursing in the Canadian Home Care Sector: What Is the Value?

Baich L, Wilson D, Cummings G. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):53–64.

Article Type: Systematic review

Description/Results:

* Literature search was completed to gather objective data regarding the value of the ET (WOC) nurse in Canada's home care sector; the search involved 9 computerized library databases. Eight studies were identified; each was analyzed using quantitative analysis.

* Results: ET (WOC) nurse involvement in home care was associated with the following benefits: reduced number of visits, reduced wound-healing times, successful healing, reduced cost of wound care, greater support for nurses and families, fewer emergency department visits, and standardized protocols for wound care.

What does this mean for me and my practice?

Provides objective data regarding positive impact of WOC nurse in home care; would be beneficial to any home care WOC nurse who is trying to justify her/his role.

W65. Effects of a Just-in-Time Educational Intervention Placed on Dressing Packages: A Multicenter Randomized Controlled Trial

Kent D. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):609–614.

Article Type: Research study

Description/Results:

* Study involved 173 nurses (43 LPNs and 130 RNs) randomized to either the control group or the intervention group.

* The control group received an unfamiliar dressing in a standard package; the intervention group received the same dressing in a package with an attached instruction sheet. Each participant was asked to complete the Kent Confidence Assessment tool and was then asked to apply the dressing to a wound model. (Company provided dressings for the study but did not have any input into study design or implementation.)

* Results: None of the nurses in the control group were able to apply the dressing to the wound model correctly, as compared to 88% in the intervention group (P < .0001).

* Nurses in the intervention group expressed confidence in their ability to apply the dressing correctly.

What does this mean for me and my practice?

This is a helpful article for any nurse who is responsible for educating other nurses in wound care; provides evidence that written instructions can be used effectively to supplement or replace face-to-face training.

W66. Measurement and Instrument Design

Pittman J, Bakas T. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):603–607.

Article Type: Integrative review

Description/Results:

* Addresses two important aspects of research: data collection and data integrity.

* Emphasizes the fact that accurate data collection is critical to valid and clinically relevant results.

* Provides in-depth review of factors to be included in instrument development: theoretical concepts, conceptual model, selection of instrument types, questionnaire construction, and establishment of validity and reliability.

What does this mean for me and my practice?

Provides practical review of the factors to be considered when selecting or developing tools for data collection, and reminds wound care nurses to carefully review data collection tools and methods when critiquing research reports.

W67. Reading Research Papers: What They Can Reveal for Practice

Steele S. Journal of Wound, Ostomy and Continence Nursing. 2010;37(3):245–246.

Article Type: Integrative Review

Description/Results:

* Provides review of the type of information that can be gained from the 3 most commonly used designs in nursing research: observational; quasi-experimental; and experimental.

* Includes review of basic techniques for critiquing research articles and for determining applicability of findings to a clinical question.

What does this mean for me and my practice?

Provides clinically relevant guidelines for reviewing research reports and interpreting the significance of the findings.

W68. Power: How to Use It in Evidence-Based Practice

Engberg S, Schlenk E. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):14–16.

Article Type: Integrative Review

Description/Results:

* Provides explanation of “power” in the context of research, i.e., the sample size required for study results to have statistical significance.

* Includes guidelines for determining if a research study has sufficient “power” to answer the study question.

What does this mean for me and my practice?

Provides helpful guidelines to the clinician in determining whether or not a research study is sufficiently powered to provide statistically significant results.

W69. Recruitment Strategies' Effectiveness for a Cryotherapy Intervention for a Venous Leg Ulcer Preventive Study

Kelechi TJ, Watts A, Wiseman J. Journal of Wound, Ostomy and Continence Nursing. 37(1):39–45.

Article Type: Integrative Review

Description/Results:

* Provided review of strategies used to recruit subjects for a randomized controlled pilot study; goals were to obtain 60 participants who reflected the demographics of the community.

* Included discussion of multiple strategies used to advertise to diverse participant pool, from perspective of effectiveness and cost.

What does this mean for me and my practice?

This provides helpful information for nurse investigators who are responsible for subject recruitment.

Copyright © 2011 by the Wound, Ostomy and Continence Nurses Society

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