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BACKGROUND

Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach.

METHODS

An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments.

RESULTS

Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed.

CONCLUSIONS

Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.

BACKGROUND

The high morbidity and mortality of esophageal defects show that the clinical challenge in the treatment of this disease still remains. An innovative method which has been developed in recent years for esophageal leakage is endoscopic vacuum therapy.

OBJECTIVES

A retrospective analysis of all patients treated for esophageal perforation with endoscopic vacuum therapy in our department was carried out.

METHODS

From November 2006 to October 2013 a total of 35 patients were treated with this method and of these 21 had anastomotic leakage, 7 had iatrogenic perforation due to flexible or rigid endoscopy and 7 patients had esophageal defects of various other origins. Drainage systems with an open pore polyurethane tip were placed using a standard endoscope. The vacuum drainage may be positioned either in the esophageal lumen onto the defect or through the defect into the extraluminal wound cavity. The intraluminal or intracavitary vacuum drainage is connected to an electronically controlled vacuum device and a continuous negative pressure of 125 mmHg is maintained for several days. The esophageal lumen or wound cavity collapses around the drainage resulting in intraluminal evacuation and closure of the defect. Under endoscopic monitoring the vacuum system is changed regularly until stable secondary healing of the intracorporeal wound or closure of the transmural defect is achieved.

RESULTS

In 32 out of 35 patients (91.4 %) healing of defects was achieved after median treatment duration of 11 days (range 4-78 days). The postoperative anastomotic leakage healed in 20 out of 21 patients (95.2 %) after a median of 11 days (range 4-46 days) of therapy. The defects in the 7 patients who were treated for iatrogenic perforation all healed (100 %) after a median treatment time of 5 days (range 4-7 days). There was one case of a recurrent fistula 75 days after treatment. The 90-day mortality in this series of 35 patients was 5.7 %.

DISCUSSION

The results of this retrospective study emphasize the increasing importance of endoscopic vacuum therapy in the current literature as an endoscopic treatment method in the management of esophageal perforation and anastomotic leakage.

OBJECTIVE

To assess the individual patient's risk of wound infection using the wounds-at-risk (W.A.R.) score developed by a group of interdisciplinary experts.

METHOD

The W.A.R. score is a clinical test in which, based on anamnestic and clinical criteria, wound patients are assigned point values, where a score of less than or equal to 3 indicates a need for antimicrobial treatment.

RESULTS

The data of 970 patients (553 women, 417 men) with chronic leg ulcers were evaluated at 10 dermatological wound clinics in different regions within Germany. The age of the patients was between 10 and 100 years (mean of 69.8 years); the duration of the wounds was between 2 months and 68 years (mean of 41.1 months). Wound sizes were between 1 and 736 cm² (mean of 42.8 cm²). Overall, W.A.R. scores of <3 points were found in 73.1% of patients and scores of greater than or equal to 3 were found in 26.9% [corrected] of patients. There were significant differences in W.A.R. scores by regions with respect to the bacterial species detected and the aetiologies of the wounds.

CONCLUSION

Our multicentre study is the first evaluation of clinical data using the newly established W.A.R. scores. We were able to show that the W.A.R. scores are able to identify a segment of the patient population for whom it can be assumed that they are prone to an increased risk of wound infections unless appropriate antimicrobial action is taken. The W.A.R. score is a simple clinical score that identifies patients with an increased risk of wound infection.

Aim: The aim of the present paper was to compare material and labour costs of a bio-cellulose dressing1 with traditional dressings (surgical pads, tulle grass, saline soaked gauze) and moist wound healing dressings.

Methods: A prospective cohort study measured clinical efficacy, materials and labour costs when using bio-cellulose dressing1 + film2 or bio-cellulose dressing1 + foam.3 60 patients with 73 complex wounds of various aetiologies were treated for a period of 1 year, in an out-patient clinic setting in Frankfurt and Neuwied, Germany and Bologna, Italy. The evaluated bio-cellulose dressing1 was combined with polyhexamethylene biguanide for reduction of bacterial burden. The present study results were compared to published data on complex wounds, treated with traditional dressings and moist wound healing dressings, to calculate cost differences.

Results: For the traditional dressings, cost calculations are based on 7.0 dressing changes/week. For moist wound healing dressings this was 3.0/week and for the bio-cellulose dressing 1.4/week. In comparison to the treatment with traditional dressings wound treatment costs with moist wound healing dressings were significantly lower. For calculation of a 3 months period, cost reduction for moist wound healing dressings was 49.4%, for bio-cellulose dressing1 + foam3 61.9% and 73.7% for bio-cellulose dressing1 + film.3

Conclusion: Moist wound healing dressings showed a cost reduction, compared to traditional dressings, with a larger cost reduction shown for bio-cellulose dressing.1 These findings are to be confirmed by randomized controlled studies.

Background: Negative pressure wound therapy (NPWT) has advanced the management of the open abdomen and other wounds. However, using the correct wound filler is essential as the material needs to convey a heterogeneous pressure distribution and create the pressure gradients required to drain interstitial fluid and remove wound exudate. This study compared the differences in fluid distribution during NPWT using a large-pore PU-foam dressing (Suprasorb1 CNP foam), drainage film (Suprasorb1 CNP drainage film) and a specialized NPT dressing system (KCI ABTheraTM NPT system) in vitro.

Methods: A tissue model was prepared from gelatine, powdered milk, and tissue marking dye. Each filler/dressing was placed on a tissue model which was connected to a fluid reservoir, linked to a TRACTM Pad and sealed. The TRACTM Pad was connected to a vacuum pump set to 120 mmHg for 8 h. An infrared camera was used to record fluid transport in the dressings.

Results: All fillers/dressings exhibited a fast fluid distribution and transport during the first hour (gradients 0.97–1.31) and steady state was reached after approximately 160 min. The NPT dressing system demonstrated a distribution limited to 70%, while the PU-foam and the drainage film presented a uniform and complete dispersal of fluid.

Conclusion: The results demonstrate that using an appropriate filler/dressing can facilitate effective wound fluid transport and drainage of interstitial fluid by producing heterogeneous pressures at the wound bed.

Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering £400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition.