Evidence-based

Thomas Serena's picture
Wound Care Clinical Trials

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

A recent article by Kaiser Health News misquoted me as saying that we enroll only "healthy" patients in our clinical trials. At moments like this, one feels that something has been overlooked. One of my research coordinators, recalling the serious adverse events (SAEs) of the previous week said, "The only patients sicker than ours are underground."

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Thomas Serena's picture
clinical research in wound care

by Thomas E. Serena, MD, FACS, FACHM, FAPWCA

The ancients sacrificed a brown dog at the beginning of the Dog Days to appease the rage of Sirius, believing that the star was the cause of the hot, sultry weather. Why a brown dog? I wonder. I think it more appropriate to register a complaint with the concierge that the air conditioner in my room is acting strange and performing poorly. But the dog days of Summer 2016 are upon us with a menacing bark and a harsh bite. I am lethargic. I am uncomfortable. I wondered whether to blog or not.

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Catherine Milne's picture
do the right thing

by Catherine T. Milne, APRN, MSN, BC-ANP, CWOCN-AP

From Nike's "Just Do It" ad campaign to Google's corporate "Don't be evil" code, I've always been struck by the many marketing campaigns that remind us to pay attention to our conscience. A similar focus should apply to health care. In 2000, the Institute of Medicine (IOM) published a scathing report showing that the number of people who died from medical errors surpassed the combined total of those who died from breast cancer and car accidents.1

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Bruce Ruben's picture
NPWT affixed to a lower extremity wound

by Bruce E. Ruben MD

Little has been shown by specific randomized controlled trials to effectively speed the healing of a non-healing wound. Biologically, the human body is capable of healing once constitutional barriers are relieved. These barriers include venous and arterial insufficiency, nutritional deficiency, deep-seated infection, and environmental barriers such as repetitive trauma.

Thomas Serena's picture
Evolution of the wound care specialist

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"The average isn't average because its average. The average is average because its best." – J.B.S. Haldane

In 1972, Stephen J. Gould, the renowned paleontologist and masterful essayist, published the theory of punctuated equilibrium in which he challenged the long held belief that evolution occurred gradually over time. He knew that the creation of new species occurred when isolated populations of individuals faced environmental challenges to which they either adapted or perished. Gould asserted that this change happened rapidly when conditions favored it. Interspersed between the spikes in speciation are prolonged periods without change (equilibrium). In the case of the human species, globalization and a fairly stable environment have resulted in negligible change in our evolutionary history: we are enjoying equilibrium.

Paula Erwin-Toth's picture
Caregiver and Client

by Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN

Fall is in full swing. The leaves in Ohio are just past their full glory, the Cleveland Browns are having another disappointing season and the debate about health care reform goes on. In other words, not much has changed from the past several years. Our clients with chronic wounds may feel the same: different day, different year, same problems with no end in sight. One wound may have healed only to recur or another erupt in a different location.

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Thomas Serena's picture
the emperor's new clothes

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

The Emperor's New Clothes was one of my favorite childhood stories. In this Hans Christian Anderson tale, two weavers clothe the emperor in what today would be referred to as "virtual finery." All of his ministers, advisers, factotums and subjects praise the beauty of the unseen linens until a small boy states the obvious truth, "Look, the Emperor is naked."

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Karen Zulkowski's picture

by Karen Zulkowski DNS, RN, CWS

Back in 2012, I blogged about glove change frequency and hand washing during dressing changes. Your comments were very informative. It is sad that facilities are being cited for not changing gloves, and rewashing and sanitizing hands during a dressing change. There is no evidence this does anything but add to the cost. What's important is to protect yourself from the patient's bacteria.

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Paula Erwin-Toth's picture

by Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN

Health care professionals recognize there seem to be 'seasons' for certain diseases and conditions. Spring and fall see a rise in flare ups of gastrointestinal disorders, such as inflammatory bowel diseases and seasonal allergies. Summer months bring an increase in traumatic events such as drownings, gunshot wounds and automobile accidents. Development of pressure ulcers does not follow a seasonal pattern—they occur at a higher than acceptable frequency throughout the year.

Thomas Serena's picture

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

The Black OPPS continues unchecked. My last blog addressed the recent Centers for Medicare Services (CMS) outpatient prospective payment system (OPPS) in regards to cellular and tissue-based products (CTPs). In the blog, I bemoaned the fact that CMS ignored the prevailing evidence for CTPs in assigning reimbursement for the various products pricing a couple of the living tissues with the most robust evidence on the market. Many of you requested our policies on CTPs, however the algorithm has changed almost daily since the beginning of the year. You will have to wait I'm afraid. In the interim, this month we will examine the change in facility payments.