Use of Topical Timolol Maleate as Re-Epithelialization Agent for Treatment of Recalcitrant Wounds of Varying Etiologies.

Background: Chronic wounds remain a challenge for the clinician and healthcare system. It is therefore vital for additional therapies that target steps involved in wound recalcitrance. Recently, topical timolol has shown promising results for use in wound healing. Objective: The goal of this study was to assess timolol's effectiveness in healing wounds of varying etiologies. Methods: This multi-center series took place from 2016¬­2019 at the wound healing centers at the University of Miami Health System and the Veterans Affairs Northern California Healthcare. We identified all wound patients who received treatment with topical timolol maleate 0.5% for at least 4 weeks after failing previous treatments. Timolol drops at a dose of 1 drop per cm2 of wound area were instilled with dressing changes twice a day, once a day, every other day, or continuous application. Once they began the study, they stopped all concurrent therapies aside from standard of care. Healing outcomes were classified into 3 categories: healed, defined as complete re-epithelialization of the wound and closure, improved, defined as decreasing wound size area (WSA), and worsening, defined as increasing WSA. Results: We identified 39 patients, 32 males and 7 females that had a total of 55 chronic wounds of varying etiologies. Thirty-four of the wounds had completely healed, 15 wounds improved in WSA, 4 wounds were unchanged in WSA, and 2 wounds worsened in WSA. Conclusions: In line with our previous experience, we found topical timolol to be a safe, cost-effective, and efficacious treatment for recalcitrant wounds of varying etiologies.

Utilidad de la toxina botulínica en el tratamiento de heridas / Usefulness of botulinum toxin in wound treatment

INTRODUCCIÓN: Se puede formar tejido cicatricial después de una cirugía, trauma o diversas afecciones inflamatorias. Las cicatrices pueden crear muchas funciones adversas, efectos cosméticos y estructurales, y a veces efectos psicológicos, eso puede afectar la vida diaria de los pacientes (Kerwin et al., 2014). El mecanismo de reparación de cicatrices a nivel molecular no es bien comprendido (Gladstone et al., 2010). BÚSQUEDA: Ensayos randomizados controlados o ensayos no randomizados, meta-análisis y evaluaciones de tecnologías que evalúen el uso de toxina botulínica en el tratamiento de las heridas y/o cicatrices cutáneas. MÉTODOS: De las 3 revisiones sistemáticas con metaanálisis encontradas se seleccionaron dos con alto nivel de confianza de acuerdo con la herramienta AMSTAR-2 que evaluaron Toxina botulínica A frente a placebo. Se evaluó el sesgo de los estudios incluidos y se realizaron perfiles de evidencia utilizando la metodología GRADE con el programa GRADE-PRO GDT teniendo en cuenta los desenlaces seleccionados como criticos o importantes. RESULTADOS: a. Evaluado en postquirúrgico de cirugía reciente, sobre piel previamente sana. b. Heterogeneidad entre estudios I2 27% y p 0,10. c. Evaluado en cocatriz hipertrófica o queloide.

COVID-19 preparedness: Clinical pharmacy services remote staffing in a quaternary, level I trauma and comprehensive stroke center.

PURPOSE: The rapid spread of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has strained the resources of healthcare systems around the world. In accordance with recommendations from the World Health Organization, Centers for Disease Control and Prevention, and US Department of Defense, Intermountain Medical Center (IMED) in Murray, UT, has developed a plan to provide remote clinical pharmacy services to protect the health of pharmacy caregivers while maintaining appropriate clinical pharmacy coverage to optimally care for patients. SUMMARY: The utilization of telemedicine technology permits clinical pharmacists to readily communicate with nurses, physicians, other caregivers, and patients. We have identified strategies to allow clinical pharmacists to continue to participate in daily rounds, provide consultations under collaborative practice agreements, verify medication orders, collect medication histories, provide antimicrobial stewardship, and deliver medication education to patients from off-site locations. The pharmacy department at IMED proactively tested telemedicine technologies, defined the roles of clinical pharmacists, and identified communication strategies prior to a rapid rise in COVID-19 cases in the state of Utah. CONCLUSION: The proactive measures described can help ensure that pharmacy caregivers have appropriate remote access and are capable of confidently using the resources. These steps allow for optimal care of hospitalized patients and promote social distancing, which may have the added benefit of decreasing the spread of SARS-CoV-2 among patients and caregivers.

Medication errors in the care transition of trauma patients.

RATIONALE, AIMS, AND OBJECTIVE: Traumatological patients are vulnerable to medication error given multiple handoffs throughout the hospital since they often require rapid diagnosis and management of multiple concurrent complex conditions. The purpose of this study was to analyze the medication errors (MEs) occurring in the care transition of the traumatological patient. The secondary objectives were to classify the MEs and the level of risk of the pharmacological groups involved. In addition, the causes and contributing factors of those MEs were analyzed. METHODS: An observational, descriptive, and prospective study, spanning 4 months, was performed in a tertiary hospital. All patients admitted to the traumatology service were selected for the study. Data were collected in different locations of the hospital stay: Emergency Service, Resuscitation and Post-Anaesthesia Unit, and Traumatology Hospitalization Unit. In each location, data from the different processes (reconciliation, prescription, validation, dispensing, and administration of medicines) were collected. The medication error (ME) was established as a dependent variable. RESULTS: A total of 31.3% (132) of the patients analyzed showed some ME. The Traumatology Unit was the location where most errors were detected, followed by the Emergency Service. Having analyzed all the locations, it was observed that 64.2% (172) of the MEs were detected in the reconciliation process, 29.5% (79) in the prescription, 3.7% (10) in the dispensing, 1.5% (4) in the administration, and 1.1% (3) in the validation. In terms of risk weighting, the drugs involved in the MEs detected were 53.8% of medium risk, 20.7% of high risk, and 20.3% of low risk. CONCLUSIONS: There is a high prevalence of MEs in the reconciliation process of medication in traumatological patients (64.2%) from our hospital setting. Interestingly, most MEs occurred in this process regardless of the location in the healthcare chain.

Cost-effectiveness of soluble beta-glucan gel in hard-to-heal wounds: an evaluation.

OBJECTIVE: To evaluate the cost-effectiveness of a soluble beta-glucan-containing gel as short-term adjunct therapy in the treatment of hard-to-heal wounds in a UK community health-care setting. METHODS: A comparative clinical evaluation involving consecutive patients treated for up to eight weeks with a beta-glucan-containing gel as adjunct to standard care. This was compared with consecutive patients as retrospective controls, and using the same standard care protocol from a year previously. The inclusion criteria was wounds that were slow-healing or stalled (<40% healing in four weeks). RESULTS: A total of 300 patients took part. Complete follow-up at 24 weeks was available for 144 patients in the beta-glucan group, and 136 patients in the standard care group. At 24 weeks, the beta-glucan group had a 96% healing rate compared with 75% in the standard care group (p<0.001). The improvement in healing was associated with a reduction in the mean number of weeks of treatment per patient (7.2 and 10.7 for beta-glucan and standard care, respectively), and a reduction in the mean cost of treatment (£576 versus £685 for beta-glucan and standard care, respectively). Treatment costs included nursing time, prescription medications and dressings. In a subset of ulcer wounds (50% of the full sample), at 24 weeks the beta-glucan group had a 92% healing rate compared with 46% in the standard care group (p<0.001). Mean weeks of treatment were 10.4 versus 17.6, leading to a reduction in treatment cost of £388 per patient (£1227 versus £839) over 24 weeks. CONCLUSION: The results of this evaluation suggest that short-term use of the beta-glucan gel as an adjunct to standard care on slow-healing wounds can shorten healing times and reduce NHS costs.

Assessment of procedural pain in French emergency departments: a multi-site, non-interventional, transverse study in patients with minor trauma injury.

Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma. Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center. Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures. Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.

Opioid prescribing in minimally injured trauma patients: Effect of a state prescribing limit.

BACKGROUND: Opioid-prescribing practices for minimally injured trauma patients are unknown. We hypothesized that opioid-prescribing frequency and morphine-equivalent doses prescribed have decreased in recent years, specifically surrounding an acute prescribing limit implemented in August 2017 mandating opioid prescriptions not exceed 210 morphine-equivalent doses. METHODS: A single-center retrospective study was performed in the month of May during the years 2015 to 2018 on minimally injured trauma patients in a level I trauma center. Minimally injured trauma patients included patients discharged within 2 midnights of trauma evaluation without surgical intervention. Primary outcomes were discharge opioid-prescribing frequency and dosing in morphine-equivalent doses. Secondary outcomes were occurrence and timing of postdischarge follow-up. RESULTS: For 673 minimally injured trauma patients, opioid-prescribing frequency and morphine-equivalent doses prescribed decreased between 2015 and 2017 (49.3% to 31.5%, P = .006, mean 229 to 146 morphine-equivalent doses, P = .007). Decreases between 2017 and 2018 were not statistically significant. Acute prescribing limit compliance was 97% in 2018. After the acute prescribing limit was implemented, outpatient opioid prescribing did not increase and time to earliest follow-up did not decrease. CONCLUSION: Opioid-prescribing frequency and morphine-equivalent doses prescribed to minimally injured trauma patients decreased dramatically between 2015 and 2018. These changes occurred primarily before the implementation of an acute prescribing limit; however, incremental improvement and high compliance since implementation are demonstrated. Patients did not have significantly earlier follow-up encounters for pain or additional opioid prescriptions. Prospective research on pain control for minimally injured trauma patients is needed.

Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.

Opioid analgesics are primarily used to treat chronic and acute pain and, when used appropriately, can be an important part of treatment (1). Pain is a major symptom of patients visiting the emergency department (ED), with up to 42% of ED visits being related to pain (2). Opioids may either be administered in the ED as part of treatment, provided post-treatment in the form of a prescription, or both (3). This report compares rates and percentages of ED visits by adults at which opioids were only given in the ED, only prescribed at discharge, or both, by selected characteristics.

3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three.

INTRODUCTION: Coagulopathy of trauma (COT) is common and highly lethal. Prothrombin complex concentrate (PCC) has been advocated for correction of COT. However, the difference in efficacy between three-factor PCC (3-PCC) versus four-factor PCC (4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC versus 4-PCC in COT. METHODS: Five-year (2013-2017) review of coagulopathic trauma patients at our Level-I trauma center who received 3- or 4-PCC. Patients were divided into two groups (4-PCC and 3-PCC) and matched in 1:1 ratio using propensity-score-matching for demographics, injury parameters, admission vitals, and hematological parameters. Primary outcomes were time to correction of international normalized ratio (INR), blood products transfusion, thromboembolic complications, and mortality. Secondary outcomes were hospital-length of stay (LOS), intensive care unit (ICU)-LOS, cost of therapy, and total hospital cost. RESULTS: Six hundred fifty-seven patients met inclusion criteria of whom 250 patients (4-PCC:125; 3-PCC:125) were matched. The mean age was 50 ±â€Š19.4 y, 64% were male, and median-injury severity score was 24[15-33]. 4-PCC was associated with accelerated correction of INR (365 vs. 428 min, P = 0.01), decrease in red blood cells (7 units vs. 10 units, P = 0.04) and FFP (6 units vs. 8 units, P = 0.03) transfused. There was no difference in platelet transfusion, thromboembolic complications, mortality, hospital, and ICU-LOS. 4-PCC was associated with higher cost of PCC therapy, and lower cost of transfusion. There was no difference regarding the total hospital cost between the two groups. CONCLUSION: Compared with 3-factor PCC, the use of 4-factor PCC is associated with a rapid reversal of INR and reduction in transfusion requirement without increasing the overall hospital cost or the risk of thromboembolic events. 4-PCC may be preferred as an adjunct for the resuscitation of coagulopathic trauma patients.

O conhecimento dos enfermeiros assistenciais no tratamento de feridas / Wound care knowledge of assistant nurses

ntrodução: Cuidar de feridas requer conhecimento específico, sendo fundamental que a equipe de enfermagem se mantenha atualizada para executar o curativo com qualidade e eficiência. Objetivo: Caracterizar o perfil da formação e atualização dos enfermeiros assistenciais e avaliar o conhecimento sobre o tratamento de feridas em um hospital público de ensino da Zona da Mata Mineira. Material e Método: Estudo observacional, descritivo e quantitativo, realizado com 32 enfermeiros de unidades de internação. Os dados foram coletados de julho a outubro de 2017, por meio de questionário estruturado validado, com questões relativas a caracterização do entrevistado, local de trabalho, aspectos da formação, atualização e tempo de atuação. Seguido por perguntas sobre a prática clínica em feridas e sobre conhecimento específico no tratamento de feridas. Resultados: Do total de enfermeiros que participaram da pesquisa, 78% informaram se atualizar sobre os cuidados com feridas, 68,8% informaram que não existe ou não sabem da existência de protocolo de prevenção ou tratamento de feridas na instituição. O hidrogel foi a cobertura primária mais conhecida e utilizada pelos enfermeiros no tratamento de feridas. De acordo com o instrumento utilizado, o escore geral de conhecimento dos enfermeiros que participaram da pesquisa foi considerado bom. As características dos entrevistados quanto a gênero, idade, setor onde atua, local de formação e turno de trabalho não interferiram no desempenho dos entrevistados. Conclusão: O conhecimento geral dos entrevistados foi considerado bom. A forma de atualização mais frequente foi perguntar a outros profissionais da área sobre suas dúvidas, seguido de leitura de artigo científico, participação em congressos e busca de informações junto a indústria farmacêutica.

Introduction: Wound care requires specific knowledge; it is essential for the nursing staff's knowledge to be updated in order to apply an efficient dressing with quality and care. Objective: To describe the educational and training profile of assistant nurses and evaluate their wound care knowledge in a public teaching hospital in Zona da Mata, Minas Gerais. Material and Method: This is an observational, descriptive and quantitative study which involved 32 inpatient unit nurses. Data was collected from July to October in 2017, through a validated structured questionnaire with questions focusing on the interviewee's characteristics, such as place of work and aspects related to training, updating and length of work. It was followed by questions about clinical practice in wounds and specific knowledge of wound care. Results: Of the nurses who participated who participated in the survey, 78% reported updating on wound care, 68.8% reported that there is no or do not know of the existence of a wound prevention or treatment protocol in the institution. The hydrogel was the most well-known primary cover used by nurses in wound care for the best known wound care used by participants. According to the instrument used, the general knowledge score of the nurses who participated in the research was considered good. characteristic of participants regarding gender, age, sector where they work, place of training and work shift did not affect the performance of respondents. Conclusion: The general knowledge of the interviewees was considered good. The most frequent update was to ask other professionals about their questions, followed by reading a scientific article, attending conferences and seeking information from the pharmaceutical industry.

Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients With Cancer.

BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice. From postimplementation chart review and clinician satisfaction surveys, the DVPRS was evaluated for the following. FINDINGS: Seventy-eight percent of nurses surveyed (N = 64) preferred the DVPRS over any other pain assessment tool. Inpatient and ambulatory patients surveyed (N = 144) agreed that a Likert-type scale in the DVPRS was easier to understand, easier to use, and better in describing their pain than the numeric rating scale.

Clorhexidina 2% con alcohol isopropílico 70%, clorhexidina solución acuosa / Chlorhexidine 2% with 70% isopropyl alcohol, chlorhexidine aqueous solution

INTRODUCCIÓN: Las infecciones del sitio quirúrgico (ISQ) y las heridas crónicas son problemas de salud con alta incidencia, prevalencia, carga de enfermedad y uso de recursos sanitarios y sociales en nuestro medio. Existen diversas tecnologías para prevenir y tratar ambos. Se solicita la incorporación de dos formas farmacéuticas de clorhexidina al subsector público de salud de la Provincia de Neuquén; clorhexidina 2% con alcohol isopropílico 70% para antisepsia de la piel en la etapa pre-quirúrgica, fundamentado en su potencial mejor efectividad para la disminución de las ISQ. También se solicita clorhexidina solución acuosa para lavado de heridas crónicas en base a una potencial mejor efectividad y menor daño tisular. LA TECNOLOGÍA: La clorhexidina es un desinfectante de acción bactericida y fungicida. Pertenece al grupo de las biguanidas . El efecto antimicrobiano del gluconato de clorhexidina es causado por disrupción de la membrana de la célula microbiana. Si bien esta molécula es de amplio espectro, tiene más efectividad sobre gérmenes gram positivos que para gram negativos. La acción contra el bacilo de la tuberculosis es mínima; no es fungicida. , es neutralizada en presencia de surfactantes iónicos, aniones inorgánicos (fosfato, nitrato o cloruro) y otras sustancias presentes en el agua corriente y preparaciones de cremas para manos y jabones neutros. No actúa sobre los virus sin cubierta, como Rotavirus y Poliovirus, aunque sí inactiva los virus con cubiertas lipídicas, como VIH y Herpesvirus. Tiene un efecto residual de 6-8 horas. El gluconato de clorhexidina debe ser almacenado a temperatura ambiente, ya que altas temperaturas, o muy bajas, pueden abolir su efecto. La vida media en envases adecuados puede ser de hasta dos años. La clorhexidina requiere ser protegida de la luz pues se descompone fácilmente. A temperaturas altas se descompone en cloroanilina y la presencia de materia orgánica no la inactiva. En nuestro país, la ANMAT autoriza la clorhexidina en solución acuosa para la desinfección de material quirúrgico. METODOLOGÍA: Para responder a las preguntas de eficacia y seguridad se realizó una búsqueda bibliográfica no sistemática a cargo de dos investigadores en forma independiente. Se priorizó la búsqueda de revisiones sistemáticas, meta-análisis, Informes de evaluación de Tecnologías Sanitarias y Guías de Práctica Clínica basadas en la evidencia. Se buscó en Cochrane, Medline, Lilacs, Tripdatabase, Epistemonikus, la base de datos de la OMS y sitios específicos de agencias de evaluación de tecnologías sanitarias. METODOLOGÍA DE COSTOS: Según la última licitación efectuada por la Subsecretaría de Salud, para compra de antisépticos, se compraron 9096 envases de 500 ml de clorhexidina gluconato 4% a un costo unitario de $69,74 (correspondientes a 18.980 litros) y 2342 envases de 1 litro de Iodopovidona solución al 5% a un costo de $69. Para esta licitación, que incluyó otros antisépticos, se gastaron $795.953, solo en estos dos productos. El costo unitario (litro de solución) de la clorhexidina 2% con alcohol isopropílico es $1700, comparado con el costo de la Iodopovidona solución al 10% ($70 x litro), lo que implica incrementar en 25 veces los costos del baño pre quirúrgico. Ante la ausencia de evidencia sólida sobre beneficios clínicos concretos, no se profundiza en el Análisis de Impacto Presupuestario, pero teniendo en cuenta que anualmente se realizan unas 25.000 intervenciones quirúrgicas en el subsector público de salud de la Provincia de Neuquén, se puede proyectar un importante incremento en los costos, en caso de considerarse incorporar esta nueva tecnología para esta indicación. Respecto a la clorhexidina en solución acuosa, el costo por litro es $340. No se puede establecer qué proporción de los antisépticos son utilizados actualmente para curación de heridas, pero cualquiera fuera el consumo, el costo se incrementaría en aproximadamente 5 veces, respecto a la clorhexidina en alcohol isopropílico y Iodopovidona al 5%. RECOMENDACIONES: Recomendación final: 1- Clorhexidina 2% con alcohol isopropílico 70% para lavado pre-quirúrgico Sentido de la Recomendación: No se recomienda su incorporación Fuerza de la Recomendación: Débil. 2- Clorhexidina solución acuosa para lavado de heridas Sentido de la Recomendación: No se recomienda su incorporación Fuerza de la Recomendación: Débil.

Assessment of clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of sloughy wounds.

OBJECTIVE: To assess use of an adjunctive topical haemoglobin spray in the treatment of sloughy wounds. METHOD: In addition to a standard wound care regimen, consecutive patients with sloughy wounds self-administered haemoglobin spray treatment twice a week until the wound was healed. All patients were followed-up for 26 weeks. Results were compared with a retrospective cohort of 100 consecutive patients, treated during the same period the previous year with standard wound care alone. Data were collected on wound characteristics including percentage of slough, exudate levels, wound pain, and wound size. RESULTS: After 26 weeks, 94/100 patients (94%) treated with haemoglobin spray were completely healed compared with 63/100 control patients (63%). Positive results were evident as early as week one with 52% mean wound size reduction using the heamoglobin spray versus 11% in the retrospective control (p<0.001). At baseline, mean slough coverage was higher in the haemoglobin group, 58% versus 44% in the control group (p<0.001). By week four, mean slough coverage was 1% in the haemoglobin versus 29% in the control group (p<0.001). Reductions in exudate and pain levels (p<0.001) were also observed. CONCLUSION: Overall, results of this evaluation showed the addition of adjunctive haemoglobin spray to standard wound care treatment achieved positive clinical outcomes for patients self-managing complicated sloughy wounds, by supporting reduction of wound exudate and slough within the complex multifaceted process of wound healing.

The impact of opioid analgesic prescription uptake on the costs of recovery from injury: Evidence from compensable orthopaedic road trauma patients.

Long-term opioid prescribing after compensable orthopaedic injury may contribute to the 'long right tail' in the cost of recovery. The aim of this study was to estimate the effect of prescription opioid uptake on injury compensation cost, using orthopaedic road traffic injury claims data from Victoria, Australia. We used a maximum likelihood estimation that accounts for potential endogeneity associated with opioid uptake, utilizing information on the doctor's differential propensity to prescribe opioids when treating other compensable injury patients. Our results suggest that opioid recipients incurred significantly greater hospital costs, income compensation payments, and medical and paramedical expenses. Overall, income compensation was the primary driver of the claim cost difference between opioid recipients and non-recipients. The findings imply that there is scope to impose restrictions on long-term opioid usage, and to encourage the use of alternative pain relief medicines.

Clinical Assessment of a Biofilm-disrupting Agent for the Management of Chronic Wounds Compared With Standard of Care: A Therapeutic Approach.

OBJECTIVE: The authors study the use of a biofilm-disrupting wound gel designed for wound management to determine if disrupting chronic wound biofilm would be therapeutically efficacious. MATERIALS AND METHODS: This prospective, randomized, open-label clinical trial was performed from September 2014 through March 2016. Forty-three patients (22 experimental, 21 control) with chronic, recalcitrant wounds were randomized to a 12-week treatment with a biofilm-disrupting wound gel (experimental) or a broad-spectrum antimicrobial ointment (control). The wound healing rate was assessed by measuring wound size reduction and wound closure rates. RESULTS: Wound size in the experimental group decreased significantly with a 71% reduction in wound area compared with 24% for the control (P < .001). Wound closure was attained in more than half of the patients (14) treated with the experimental product. Fifty-three percent of these patients achieved closure by 12 weeks as opposed to 17% for the control (P < .01). No adverse events related to the experimental product were recorded, but 2 adverse reactions occurred with the control. CONCLUSIONS: The combination of the experimental product and wound debridement significantly improved wound healing rates by disrupting the biofilm, which protects multispecies bacteria within a chronic wound. Given the significant wound size reduction and closure rates observed in these long-term, nonhealing wounds, as well as the lack of related serious adverse events, the investigators believe the biofilm-disrupting wound gel to be a safe and effective treatment for recalcitrant chronic wounds.

Apósito para la difusión de oxígenio en tratamiento de heridas (hemoglobina carboxílica) / Dressing for the diffusion of oxygen in the treatment of wounds (carboxylic hemoglobin)

ANTECEDENTES: Se solicita al IETSI la evaluación y Validación de la tecnología "Apósito para la difusión de oxígeno en tratamiento de heridas (hemoglobina carboxílica) según CARTA número 6411-GRAR-EsSalud-2016. El "Apósito para la difusión de oxígeno en tratamiento de heridas (hemoglobina carboxílica)" es un dispositivo médico coadyuvante indicado en el tratamiento de las heridas crónicas de la piel como las úlceras venosas, arteriales o mixtas, úlceras diabéticas, heridas quirúrgicas que no cicatrizan y úlceras de presión. Este apósito suministra mayor cantidad de oxigêno localmente a las células en el lecho de la herida lo cual mejora el processo de regeneración de los tejidos y consiguiente cierre de la misma. Según lo solicitado, el uso en EsSalud seria para el tratamiento de las úlceras crónicas de evolución tórpida de etiologia fundamentalmente isquémica. METODOLOGÍA: El análisis ha consistido en una búsqueda y evaluación de la evidencia científica actual sobre el uso de la tecnologia bajo el nomre de "Hemoglobina tópica" o "hemoglobina en aerosol" o en inglés: "Topical Hemoglobin" or "hemoglobin spray". Se realizó una evaluación de estudios descriptivos, guías, revisiones sistemásticas, meta-análisis, ensayos clínicos, entre otros, en las seguientes bases de datos referenciales hasta diciembre 2016: Pubmed, Science Direct, EMBASE, EBSCO, Scielo, así como información proporcionada por grupos internacionales o agencias internacionales que realizan revisiones sistemáticas, evaluación de tecnologías sanitarias tales como The Cochrane Library y el national Institute for Health and Clinical Excellence (NICE). ANÁLISIS DE LA EVALUACIÓN: Según la evidencia científica revisada, se encuentra actualmente estudios acerca del dispositivo "Apósito para la difusión de oxígenio en tratamiento de heridas (hemoglobina carboxílica)", siendo en su mayoria cohortes observacionales. Solo se encontró dos estudios de tipo ensayo clínico que evaluaron su efecto el tamaño del área de la superfície de heridas en pacientes con úlceras venosas crónicas. CONCLUSIÓN: El Dispositivo Médico "Apósito para la difusión de oxígenio en tratamiento de heridas (hemoglobina carboxílica)" no cuenta a la fecha con evidencia científica que demuestre su efectivadad y seguridad en el tratamiento de heridascrónicas de piel de evolución tórpida. Los ensayos aleatorizados y estudios observacionales revisados presentaron limitaciones principalmente debido a debilidades metodológicas.

The cost-effectiveness of a novel soluble beta-glucan gel.

OBJECTIVE: Wounds that have stalled healing are costly in terms of patient morbidity and increase in use of material and financial resources. A natural polymer beta-glucans has been incorporated into a methylcellulose gel to provide a topical gel designed to accelerate healing in wounds where it has stalled. Although the gel provides an environment conducive to moist wound healing the active agent, beta-glucans, activate the innate immune response. METHOD: Using a Markov cohort simulation model, data were extrapolated from a double-blind randomised trial to evaluate the economic benefits of the soluble beta-glucan (SBG) gel in the treatment of diabetic foot ulcers (DFUs). RESULTS: Over an annual budget cycle, SBG gel is expected to heal 94% of wounds compared with 78% when given standard care. It also healed wounds more quickly, with the average expected healed weeks 34.4 in the SBG gel group, compared with 24.7 methylcellulose dressing group. In our model this leads to a cost saving over an annual budget cycle of £503 per patient. Note: healed weeks refers to the number of weeks when the wound has healed during the 12-week period and should not be confused with weeks to healing. CONCLUSION: The shorter healing time associated with the SBG gel treatment leads to a cost saving because fewer weeks of treatment are required to heal the wound, suggesting this is a promising new cost-effective option for the treatment of DFUs.

Nano-silver-decorated microfibrous eggshell membrane: processing, cytotoxicity assessment and optimization, antibacterial activity and wound healing.

An ideal wound dressing can both promote wound healing and prevent bacterial infection. Here, we report a potential dressing prepared by incorporating an optimized concentration of silver nanoparticles (AgNPs) into the microfibers of a natural eggshell membrane (EM) using environmentally friendly and mussel-inspired dopamine. Briefly, acid-treated EM was used as a porous membrane for polydopamine-reduced AgNPs synthesis. To obtain the optimal cytocompatible silver concentration, cellular attachment and MTT assay were performed with different concentrations of AgNPs. The morphology of the EM and AgNPs was confirmed by scanning electronic microscopy, scanning transmission electronic microscopy and Fourier transform infrared spectroscopy. The synthesized EM/AgNPs exhibited steady and safe AgNPs release, which was further tested for antibacterial activity against Escherichia coli and Staphylococcus aureus by disc diffusion method and bacterial suspension assay. Finally, in a murine full-thickness skin wound model, we found that EM/AgNPs could promote re-epithelialization, granulation tissue formation and wound healing via enhancing cell proliferation, as demonstrated by the expression of proliferating cell nuclear antigen (PCNA), and controlling inflammation response, as demonstrated by the expression of interleukin-1ß (IL-1ß). These findings suggest that EM/AgNPs may have a promising application in wound management.

Injecting rabies immunoglobulin (RIG) into wounds only: A significant saving of lives and costly RIG.

An increasing number of dog bite victims were being presented to public hospitals in Himachal Pradesh in 2014 amidst virtual non availability of any rabies immunoglobulin (RIG). Only a small quantity of equine rabies immunoglobulin (eRIG) was available from the government owned Central Research Institute (CRI) Kasauli. This available eRIG was used in 269 patients as an emergency response and only for local infiltration of severe bite wounds by suspected rabid dogs. This was followed by rabies vaccination, using the WHO approved intra-dermal Thai Red Cross Society vaccination schedule. A subgroup of 26 patients were later identified who had been severely bitten by laboratory confirmed rabid dogs. They were followed for more than one year and all were found to be alive.