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Biomedical subjects

L van Rijswijk

Publications and source records attributed to L van Rijswijk.

At least 37 records · Page 2Linked to original sources
PubMed1998

Improved coordination: the wound care specialist.

Optimal, cost-effective patient care requires the integration of research findings into practice and a continuing assessment of outcomes attained, which cannot be achieved unless care is continuous and multidisciplinary. Well-defined requirements for the education of an advanced practice nurse results in quality and effective wound-care delivery in a cost-effective fashion. The concerns of business and health must be blended to achieve optimal patient care.

Cost-Benefit Analysis↗
PubMed1996

The fundamentals of wound assessment.

Although many questions related to the process of wound assessment remain unanswered, clinicians agree on one issue: it is better to regularly assess using the same, possibly less-than-perfect tool, than to not assess at all. This article discusses the fundamentals of wound assessment, beginning with defining "assessment." The rationale for wound assessment is based on the goal of care and patient care plan. Frequency depends on the rationale for a particular patient and may, therefore, change over time. Assessing the wound involves a number of steps, beginning with choosing reliable and valid wound assessment methods, which often include: measuring wound area/size and depth, assessing the wound edges, aspect of the wound bed and surrounding skin, as well as the amount and type of exudate and odor. Consistent documentation of all findings is crucial. Wound assessments provide the foundation for the plan of care and are the only way to determine its effectiveness.

Algorithms↗
PubMed1995

Using wound debridement to help achieve the goals of care.

The removal of devitalized tissue, particulate matter, or foreign materials from a wound, debridement, is often the first goal of wound care. Debridement can be accomplished surgically (instrument/sharp), chemically, mechanically or by means of autolysis. Each procedure has distinct advantages, disadvantages, indications for use and risks, and a combination of methods will often expedite the process while limiting the chance of complications. Depending on the method used as well as a variety of local and systemic factors, chronic wound debridement can take anywhere from a few days to more than a month. Even though wound debridement is often discussed separately, particularly when managing patients with chronic wounds, it should not be viewed in isolation. Rather, it is one aspect of total patient care. Measures to facilitate the healing process in general should be employed at all times, because debridement and wound healing can occur simultaneously.

Clinical Competence↗
PubMed1994

Pressure ulcers in extended care facilities: report of a survey.

A survey including 15 extended care facilities with access to ET nurse consulting services was conducted to assess current wound care protocols, practices, and educational backgrounds as well as requirements. Sixty-seven percent of facilities surveyed used a system to describe pressure ulcers. Wound care was provided by licensed practical nurses in 90% of the institutions and product decisions were made by the physician in 65% of facilities surveyed. Gauze-type dressings were used most frequently on all stages and types of pressure ulcers. A significant correlation between ulcer type and dressings used was found for stage II pressure ulcers only. Hydrocolloid and polyurethane film dressings were more likely to be used on stage II ulcers without exudate than on any other type of ulcer (p < 0.001). The ET nurse and a variety of other professionals, including product manufacturer representatives, were consulted to assess complicated wounds. In 9 of 15 instances, the ET nurse was rated as the best source of practical wound care information. Respondents preferred wound care meetings that were practical, included all levels of health care providers, focused equally on treatment and prevention, and were not expensive to attend.

Bandages↗
PubMed1994

Predictors of time to healing deep pressure ulcers.

Time to healing analysis methods (Kaplan-Meier time until healing curves) were used to compare time to healing deep pressure ulcers as a function of patient and wound characteristics at baseline and after two weeks of treatment. Time to healing was significantly reduced in patients who had a good nutritional status. Patients who were alert and coherent were also found to heal more expediently; however, mental status was not independently predictive of time to healing in the multivariable model. Larger wounds took longer to heal (median 20 days) than smaller wounds, but the difference was not statistically significant. After two weeks of treatment, ulcers in patients who were 60 to 70 years old, who had a good nutritional status at baseline and whose ulcers reduced at least 39 percent in size after two weeks, were found to heal much more expediently. Cox regression models showed that these factors were independently predictive of time until healing (Likelihood ratio statistic on 5 DF = 26.485, p < 0.001). Clinical assessments, both at baseline and regular intervals thereafter, may predict treatment outcome of full-thickness pressure ulcers.

Aged↗
PubMed1993

Full-thickness pressure ulcers: patient and wound healing characteristics.

To investigate the patient and healing characteristics related to full-thickness pressure ulcers, 119 consecutive patients admitted with ulcers in three acute care, four longterm care, and one rehabilitation agency were studied. Of the 119 patients with 153 pressure ulcers, only 48 (40%) had full-thickness ulcers. Compared to patients with partial-thickness ulcers, patients with full-thickness ulcers were more likely to have multiple ulcers, occasional incontinence of urine and feces, a compromised overall skin condition, and a less than optimal nutritional status at baseline. Full-thickness ulcers treated with a hydrocolloid dressing (DuoDERM Hydroactive) did not develop adverse reactions; clinicians perceived the dressing to be efficacious. Ulcers that healed during the study decreased 47% in area in two weeks. This distinguished ulcers that healed from those that did not heal. The findings suggest that ulcers that do not decrease in size within two weeks should be reevaluated for additional or alternate treatments.

Aged↗
PubMed1993

Full-thickness leg ulcers: patient demographics and predictors of healing. Multi-Center Leg Ulcer Study Group.

BACKGROUND: Despite increased knowledge about the immediate and underlying causes of chronic leg ulcers, their management remains a challenge. Some ulcers rapidly respond to treatment whereas others do not, and the decision to reassess the patient and treatment modality is usually based on the clinician's own experience. METHODS: Following diagnosis of the underlying cause of leg ulcers, 181 patients were screened. The use of a hydrocolloid dressing (DuoDERM) was evaluated in the treatment of 61 patients with 72 full-thickness ulcers. Patient characteristics associated with deep wounds as well as patient and wound characteristics predictive of the extent of healing and time required for healing were identified. RESULTS: Patients with full-thickness ulcers were more likely to be overweight (P < .001) and not fully mobile (P = .016). During a mean treatment time of 56 days, 54% of the full-thickness ulcers healed. Ulcers were less likely to heal if the patients were men (P = .02) or had diabetes mellitus (P < .003). A > 30% reduction in ulcer area after 2 weeks of treatment was a predictor of both treatment outcome (P = .016) and time required for healing (P = .004). Odor at baseline and advanced age also were associated with increased time required for healing (P = .005 and .017, respectively). CONCLUSIONS: Noninvasive clinical assessments can aid the clinician in predicting treatment outcome and may facilitate the decision to change therapy and evaluate treatment compliance.

Age Factors↗
PubMed1991

Wound dressings: meeting clinical and biological needs.

Central to any type of wound therapy is understanding the pathophysiology of healing and danger signals of the most common chronic wounds. This article discusses wound assessment, healing of acute and chronic wounds, factors that retard healing, and summarizes controlled clinical wound dressing literature.

Bandages↗
PubMed1990

Nursing research and dermatology: where to start.

Nursing research can provide the professional growth necessary to ensure the future and credibility of dermatology nursing. This article explains common research definitions, controls, instrumentation, blinding, analysis, and where to seek help for your research project.

Data Collection↗
PubMed1990

Industry and dermatology research: how well can they work together?

Nursing roles in clinical research are expanding as biomedical technology advances and corporate funding for patient-oriented research increases. Collaboration between nurse investigators and industrial sponsors can lead to the successful application of new knowledge and improved health care if the objectives of both parties are understood and appropriate agreements ensue.

Clinical Trials as Topic↗
PubMed1987

Evaluation of a new dressing in the treatment of sports-related skin lesions.

Twenty-seven players with superficial wounds (abrasions, turf burns, and blisters) were treated with a new Hydroactive dressing. We conclude that this dressing provides an excellent alternative to other forms of treatment since it is easy to use, comfortable, hypoallergenic, and provides impressive healing results.

Adult↗
PubMed1985

Multicenter clinical evaluation of a hydrocolloid dressing for leg ulcers.

The need for a moist environment for the normal healing process led to the development of occlusive dressings. Results from this study support the contention that a moist wound environment is favorable to the healing process in humans as well as in animal models. Hydrocolloid dressings are effective in the practical daily management of chronic and even refractive ulcerations of the lower extremities and offer a time-saving treatment alternative with a high degree of patient acceptability.

Adolescent↗
PubMedDate not supplied

Documentation with MDS Section M: Skin Condition.

The Minimum Data Set is designed to be the assessment instrument used in all long-term-care facilities receiving federal funds for Medicare and Medicaid. However, Section M: Skin Condition is one of the most challenging sections to complete when trying to match the Minimum Data Set documentation with the true clinical picture. If wounds are not adequately assessed and documented, outcomes of care cannot be evaluated, and treatment and prevention plans will be inadequate. This may result in less than optimal outcomes and possible lawsuits for inadequate care against both the caregiver and facility. The purpose of this article is to provide examples of medical record documentation necessary to support the Minimum Data Set assessment.

Documentation↗