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Biomedical subjects

D Krasner

Publications and source records attributed to D Krasner.

At least 19 recordsLinked to original sources
PubMed2000

The potential benefits of advanced therapeutic modalities in the treatment of diabetic foot wounds.

This article discusses the advantages and disadvantages of primary wound healing as compared with primary amputation in individuals with chronic diabetic foot wounds. The authors review the potential benefits of vascular surgical procedures and advanced dressings, including two of the most promising modalities in modern wound care: growth factors and bioengineered skin. In this era of cost-conscious health-care administration, it is incumbent on the practitioner to consider not only the basic science of wound care, but also the economic aspect of treatment rendered. These various interventions, dressings, growth factor delivery systems, and new modalities could significantly reduce healing time, thereby reducing the risk of infection, hospitalization, and amputation while improving quality of life. If so, they may be truly cost-effective.

Bandages↗
PubMed1999

The AHCPR pressure ulcer infection control recommendations revisited.

The 1994 AHCPR Pressure Ulcer Treatment Guideline had five recommendations on infection control topics. A review of the literature since mid-1993 when the evidence to support these recommendations was undertaken is reported on here. The author suggests that the recommendations be revisited in light of two recent quasi-experimental studies, but since no randomized controlled trials were found, the strength-of-evidence ratings should remain at C for all five recommendations. Infection control for chronic wound care is a complex issue and is clearly in need of further research. In the meantime, common-sense, reasonably prudent, do-no-harm interventions should be considered best practice.

Bandages↗
PubMed1998

Painful venous ulcers: themes and stories about living with the pain and suffering.

PURPOSE: Describe and explore the meaning of the experience of living with painful venous ulcers. SUBJECTS AND SETTING: Fourteen people with active painful venous ulcers at the time of initial interview at an outpatient wound center. METHOD: A descriptive qualitative approach, known as Heideggerian hermeneutic phenomenology was used for this study. Semistructured interviews were audio taped, transcribed, and analyzed using Martin Qualitative Analysis Software. RESULTS: Four of the eight most compelling themes identified by the patients are reviewed in this article. These themes are expecting pain with the ulcer, swelling equals pain, not standing, and starting the pain all over again (painful débridements). CONCLUSIONS: The identified pain descriptors and the constitutive pattern "carrying on despite the pain" have important implications for WOC nursing practice, education, and research.

Activities of Daily Living↗
PubMed1998

Diabetic ulcers of the lower extremity: a review of comprehensive management.

The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at prevention have been less successful. The etiology of lower extremity diabetic ulcers includes injury complicated by underlying neuropathy, ischemia, or both. Prevention of primary and recurrent ulcers can be increased through programs to educate patients and caregivers. Proper management begins with thorough assessment and continues with various forms of medical and surgical therapy, and timely referral to specialists when appropriate. The use of recombinant growth factors is becoming more widespread as more is learned about their essential role in wound healing. Monitoring the wound while it is being treated is as important as initial assessment. Across the United States and Canada, wound care clinics are being established to provide intensive care directed by specially trained multidisciplinary care teams. Less populated areas must rely on proper education of ET nurses, home care nurses, visiting nurses, podiatrists/chiropodists, and allied healthcare professionals. Challenges for the future include the development of protocols for comprehensive assessment and care, better methods of prevention, a greater understanding of the role of growth factors in wound healing, and optimizing wound care.

Diabetic Foot↗
PubMed1998

Painful venous ulcers: themes and stories about their impact on quality of life.

The purpose of this dissertation research was to describe, to understand and to interpret the meaning of the experience of living with painful venous ulcers. Heideggerian hermeneutic phenomenology, a descriptive, phenomenological approach, was the design used for this study. Fourteen people with active painful venous ulcers at the time of initial interview were engaged in conversation. The semi-structured interviews were audiotaped, transcribed and analyzed using Martin Qualitative Analysis Software (version 2.0). Four of the eight most compelling themes that relate to quality of life are reviewed here: feeling frustrated; interfering with the job; making significant life changes; and finding satisfaction in new activities. Increased sensitivity to and understanding of the impact of painful venous ulcers on QOL may lead to more effective intervention strategies and improved outcomes for these patients.

Activities of Daily Living↗
PubMed1997

Recommendations for using reverse staging to complete the MDS-2.

The use of the Minimum Data Set (MDS) for documentation in long term care has resulted in the widespread reliance on reverse staging to document the healing of pressure and venous ulcers. This article presents a pragmatic approach for defining the healing process in a staging nomenclature so that it is physiologically accurate.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Wound Healing Scale, version 1.0: a proposal.

The Wound Healing Scale is a user-friendly, descriptive scale for assessing healing in all types of wounds, both acute and chronic. The scale consists of eight alphabetic modifiers that can be combined with the score from a number of different existing scales that assess wounding. The WHS can be utilized with large and small data sets and resolves the problem of reverse staging posed by regular reassessments using the Health Care Financing Administration's Minimum Data Set, version 2.0.

Acute Disease↗
PubMed1996

Using a gentler hand: reflections on patients with pressure ulcers who experience pain.

Nurses who care for patients with pressure ulcers who experience pain were asked to reflect and write a story about this phenomenon. The objective of this study was to determine the meanings derived from nurse caregivers' reflections about patients' pressure ulcer pain. A Heideggerian hermeneutical approach was the methodology used for this inquiry. Stories from 42 participants, including nurse generalists and advanced practice nurses, were analyzed. Input was solicited from two qualitative research teams. Findings consist of three constitutive patterns and eight related themes: Nursing expertly (reading the pain, attending to the pain, and acknowledging and empathizing); Denying the pain (assuming it doesn't exist, not hearing the cries, and avoiding failure); Confronting the challenge of pain (coping with the frustrations and being with the patient). Lessons learned from this analysis are to stay connected with your patients; listen, attend ("be with") and comfort; and use a gentler hand.

Adaptation, Psychological↗
PubMed1995

Research & writing basics: elements of the abstract.

Writing an abstract is a challenging skill that requires precision and care. Criteria for well-formulated abstracts and abstract guidelines for 2 types of articles (empirical studies and reviews or theoretical articles) as well as a description of the content of a structured abstract are presented. Details were gleaned from a review of the literature including the American Medical Association Manual of Style, Eighth Edition and the Publication Manual of the American Psychological Association, Fourth Edition. A good abstract is like a crystal: it is a clear, sharp synthesis that elucidates meaning for the reader.

Abstracting and Indexing↗
PubMed1995

The chronic wound pain experience: a conceptual model.

Chronic wound pain is experienced to a greater or lesser degree with most types of chronic wounds, yet research to date on this subject has been extremely limited. This article presents an empirically and inductively derived model, including a theoretical definition of the chronic wound pain experience (CWPE) and its subcomponents (noncyclic acute wound pain, cyclic acute wound pain and chronic wound pain). The model relates the CWPE to the nursing process and to nursing diagnoses and proposes intervention schemes to optimize patient outcomes. Avenues for future research are delineated.

Chronic Disease↗
PubMed1995

AHCPR Clinical Practice Guideline Number 15, Treatment of Pressure Ulcers: a pragmatist's critique for wound care providers.

The AHCPR Clinical Practice Guideline: Treatment of Pressure Ulcers is a comprehensive, one-stop reference with enormous utility for wound care providers in a diverse array of settings. Following a brief review of the Guideline development process, the Guideline is critiqued using a pragmatic perspective. Five specific issues are discussed in detail, followed by recommendations to providers for addressing these concerns. Guideline No. 15 is not a perfect document and it should not be taken as the final word on the subject of pressure ulcer care.

Humans↗