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Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 10

A house call to a delightful 78-year-old lady revealed a history of a hip prosthesis placed three years earlier that unfortunately had become infected. When the first surgeon could not be found (he had moved out of state just in time), his associate opened the hip, carefully lavaged out the “Root Beer Float” material (per the family, an interesting description if I ever heard one), and then closed the hip primarily.

Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

The past few months I have written about legal cases and palliative care. My plan was to combine them for March. However, my husband had a partial knee replacement at the end of February and I wanted to write about that. My apologies for no March column.

Aletha Tippett MD's picture

By Aletha Tippett MD

With a theme this month of dressings, I think it is time to give gauze its rightful due. There are a number of wound care providers who would say that “gauze has no cause”. Of course, this is said because of the understanding that moist gauze dries out when on a wound, leading to “wet to dry”, which is a major no-no according to CMS. This wet-to-dry results in debridement of viable tissue. It is also because of the belief and practice that a gauze dressing needs to be changed daily, and with all the cost-consciousness, this makes it more expensive than a once-a-week higher end dressing. However, in real life, how often does a once-weekly dressing actually last the full week, especially on a sacral or buttock wound?

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Laurie Swezey's picture
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By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

There are more than 3,000 types of wound dressings available on the market today, and more are being launched every day. Although there are a number of protocols and algorithms available to help with the selection of wound dressings,1,2 and individual facilities are likely to have their own dressings of choice, the decision can still seem overwhelming. Even the most seasoned wound care practitioner can find it difficult to assess the advantages and disadvantages of each dressing available and to make the appropriate choice for a particular patient. Rather than consider each dressing in isolation, a useful technique can be to mentally place each type of dressing on a continuum of occlusion.3

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Kim Coy Decoste's picture

By Kim Coy DeCoste RN, MSN, CDE

It can be quite concerning when you ask your patients attending a DSME class “How many of you have had your feet checked for blood flow and nerve function by your health care provider?”, and far less than half of them raise their hands. Probing a little further, you find that a number of patients have never even had their feet visually inspected by their health care provider (HCP) for signs of diabetic foot ulcers. This isn’t unique to my practice site. Recently when I was teaching a professional education program with diabetes educators from across the US, most in the group concurred with my findings.

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

One component of the nutritional assessment process in wound care is reviewing and evaluating biochemical data. In a previous blog I discussed the relationship of albumin and pre-albumin (transthyretin) to nutritional status. Many lab values are affected by hydration status and/or medications, which may increase or decrease levels.

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Ron Sherman's picture

By Ron Sherman MD, MSC, DTM&H

Numerous controlled studies of maggot therapy have been published during the past 20 years, each one demonstrating equality or superiority over standard care methods for debridement. It is almost as though we are trying to compensate for the previous 60 years of extensive clinical use supported only by case histories, but no clinical trials.

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Glenda Motta's picture
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By Glenda Motta RN, MPH

Say what you will about Obamacare, but the President has made eliminating fraud, waste, and abuse in healthcare a top priority. The Attorney General and Health and Human Services (HHS) Secretary recently released a report on health care fraud prevention and enforcement efforts in Fiscal Year (FY) 2011.1 Nearly $4.1 billion was recovered, the highest ever reported. The Health Care Fraud Prevention & Enforcement Action Team (HEAT) works to prevent fraud, waste, and abuse in the Medicare and Medicaid programs. Their efforts and other approaches are being expanded using tools authorized by the Affordable Care Act.

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Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 9

One of the most obvious things about being a health care professional is that our goal is to help people get better. The concepts of an ill patient saying to me, "Dr. Miller, I don't want to get better or worse, can you do something to keep me in this condition?" Seems ludicrous and more, improbable. I could not imagine any health care professional being successful if patients remained in the exact same condition weeks after treatment. As I have said in previous blogs, I recognize that while there are many variations on the definition of "better", I think it's safe to say that "better" means improved in some way, shape, or form.

Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 8

“…(7) Go to, let us go down, and there confound their language, that they may not understand one another's speech.(8) So the Lord scattered them abroad from thence upon the face of all the earth: and they left off to build the city. (9)Therefore is the name of it called Babel..." (Genesis, Chap. 11).

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