Search

Photoacoustic imaging is an emerging imaging modality whereby pulsed laser illuminationgenerates pressure transients that are detectable using conventional ultrasound. Plasmonicnanoparticles such as gold nanorods and spheres are commonly employed exogenous contrastagents for both sensing and therapeutic applications. This dissertation first presents a detailedreview of engineering plasmonic nanoparticles for enhanced photoacoustic imaging followed bythe design of iodide and chalcogenide doped silver-coated gold nanorods for oxidative stresssensing and enhanced photoacoustics. Clinically, photoacoustics leverages hemoglobin andmelanin as endogenous contrast agents for breast, vascular, and wound imaging. The rest of thisdissertation focuses on the use of ultrasound and photoacoustic imaging to monitor and predictchronic wound healing in human subjects. Chronic wounds are a major health problem that causethe medical infrastructure billions of dollars every year. Chronic wounds are often difficult to healxxiiand cause significant discomfort. Although wound specialists have numerous therapeuticmodalities at their disposal, tools that could 3D-map wound bed physiology and guide therapy donot exist. Visual cues are the current standard but are limited to surface assessment; clinicians relyon experience to predict response to therapy. Photoacoustic imaging can solve these majorlimitations. Chronic wound patients often receive skin grafts to promote tissue regeneration, butgrafting makes it impossible to monitor the underlying wound bed. Ultrasound imaging can beused to size wounds in three dimensions, monitor, and predict tissue loss or regeneration under askin graft. The addition of photoacoustic imaging allows functional imaging of angiogenesis andperfusion into the wound bed, both essential for wound healing. An increase in photoacousticsignal corresponds to higher perfusion and the rate of photoacoustic signal increase can predict ifa wound is likely to heal or not. Clinical photoacoustic imaging can be limited by melanin, a majoroptical absorber giving skin its characteristic color. Subjects with darker skin tones and hence highmelanin content absorb more photons leaving less light to probe deeper tissues of interest. Thebias against darker skin tones subjects can be easily minimized by designing tools that account forvariable melanin concentrations.

Aim: this study aimed to determine the problems faced by physicians and nurses dealing with chronic wound care during the COVID-19 pandemic and their views on telehealth. Materials and methods: a descriptive and cross-sectional design was used in this study. The sample comprised physicians (n = 74) and nurses (n = 271) interested in chronic wound care. Data were collected through a questionnaire form consisting of open- and closed-ended questions. Results: of the participants, 21.4% (n = 74) were physicians and 78.6% (n = 271) were nurses. Of the physicians, 45.9% (n = 34) were obliged to work in another unit during the COVID-19 period, while 43.2% continued their service related to chronic wound care, and only 17.0% (n = 18) in the wound care service before the pandemic. These rates are 51.3% (n = 139), 51.6% (n = 157) and 36.8% (n = 128) for nurses, respectively. 40.7% of the physicians (n = 33) and 34.9% of the nurses (n = 106) stated that their time had been reduced for chronic wound care. When the telehealth experiences were examined, 32.4% (n = 24) of the physicians utilized telehealth, 29.7% (n = 22) used e-visit, 77.0% (n = 57) stated that they thought telehealth was a good option, 47.3% (n = 35) utilized it for wound evaluation and treatment, and 31.9% (n = 59) used smart phones. These rates for nurses were 16.6% (n = 45), 14.0% (n = 38), 72.7% (n = 197), 33.9% (n = 92), and 27.0% (n = 182), respectively. Conclusions: the COVID-19 pandemic negatively affected the manner of delivery, duration, and quality of service regarding wound management. During this period, face-to-face contact times with patients were reduced, some diagnosis and treatment attempts were not performed, and wound care services were suspended temporarily or permanently. On the other hand, a positive result was achieved in that the physicians and nurses gave positive feedback for the telehealth experience., NA

A prototype medical device and protocol that work well in a clinic would not necessarily work reliably in the home setting. The goal of this work is to identify factors to consider when translating a device evaluated in a clinic for use by home caregivers providing chronic wound care for persons living with dementia. One must consider the current device, the associated bundle, the protocol and how they may need to be modified. Semi-structured interviews with the research assistants who have applied a prototype device were conducted to generate a list of known issues with the current clinical protocol in terms of ultrasound application The researchers performed a set of specified tasks by following the current device protocol and explaining any difficulties with use\execution. They embellished the descriptions with details about what had happened with actual patients in the clinic. Using thematic analysis, analysts identified themes and subthemes. Issues potentially relevant to translating medical devices to the home are discussed.

Julie Penfold highlights the importance of evidence-based practice in wound care to reduce the burden on patients and healthcare services.

Repeatedly changing dressings during wound healing can cause unbearable physical pain for patients with chronic skin injury. In this study, we designed a tough hydrogel-based dressing that can be degraded in an on-demand fashion for advanced chronic wound care. The resultant hydrogel dressing could be rapidly dissolved within 100 s after wetting with lithium phenyl(2,4,6-trimethylbenzonyl)phosphinate solution under low-power (1 W) ultraviolet (UV) irradiation (365 nm) owing to the breakage of disulfide bonds. This UV-triggered on-demand dissolution of tough hydrogels allows for a facile dressing replacement without causing tissue damage or pain, which is of great potential for clinical utilization.

Introduction Extracorporeal shock wave therapy (ESWT), first described in the eighties for the treatment of urolithiasis, has also been applied in other fields such as orthopaedics and chronic wound care. Recently it has also been used in the treatment of burns and its sequelae since several studies suggest it could be an important tool in the conservative management of these conditions. The aim of this article is to review the literature for published evidence on the use of ESWT for the treatment of acute burn patients and its sequelae and to elaborate a brief report on the current state of the matter. Material and methods We carried on a search on PUBMED database and Cochrane database with the following terms: (‘burns’ [title/abstract] OR ‘burn’ [title/abstract]) AND “shock wave” ([title/abstract]). For an optimal reporting of the studies found we followed the PRISMA statement. Results This search found 34 articles from which only 15 were actually related to the use of ESWT in burn patients. From these 15 articles, 7 involved the use of ESWT in the treatment of acute burns, 6 related to its application in post-burn scars, 1 in the treatment of heterotopic ossification and 1 was about the use of ESWT in skin-graft donor site. Except for the latter, all of them were carefully reviewed. Conclusion Scientific evidence on the use of ESWT for the treatment of burn patients is weak due to the paucity of studies and their low quality. However, ESWT seems to be a promising tool in this field and therefore more high-quality trials should be conducted.

The purpose of this study was to describe the level of chronic wound‐care competence among graduating student nurses and student podiatrists in comparison with that of professionals and to develop and test a new instrument (the C/WoundComp) that assesses both theoretical and practical competence in chronic wound care as well as attitudes towards wound care. The data (N = 135) were collected in 2019 from four groups (1): graduating student nurses (n = 44) (2); graduating student podiatrists (n = 28) (3); registered nurses (n = 54); and (4) podiatrists (n = 9). The data were analysed using statistical analysis. According to the results, the students' total mean competence score was 62%. Their mean score for theoretical competence was 67%, and for practical competence, it was 52%. The students' competence level was statistically significantly lower than that of the professionals (P

Chronic non-healing wounds are estimated to cost the US healthcare $28-$31 billion per year. Diabetic ulcers, arterial and venous ulcers, and pressure ulcers are some of the most common types of chronic wounds. The burden of chronic wounds continues to rise due to the current epidemic of obesity and diabetes and the increase in elderly adults in the population who are more vulnerable to chronic wounds than younger individuals. This patient population is also highly vulnerable to debilitating infections caused by opportunistic and multi-drug resistant pathogens. Reduced microcirculation, decreased availability of cytokines and growth factors that promote wound closure and healing, and infections by multi-drug resistant and biofilm forming microbes are some of the critical factors that contribute to the development of chronic non-healing wounds. This review discusses novel approaches to understand chronic wound pathology and methods to improve chronic wound care, particularly when chronic wounds are infected by multi-drug resistant, biofilm forming microbes.

BackgroundChronic wounds affect an estimated 2.21 per 1000 population. They are a significant source of morbidity and affect individuals physically, psychologically, socially and financially. Person-centered care is one approach to improve patient outcomes in wound care as it values patients' perspectives, beliefs and autonomy and considers the person as a whole within the cultural context in which care is provided.AimWe aimed to review the evidence on the use of person-centered care (PCC) in chronic wound care management and provide recommendations for practice and future research.MethodUsing a systematic review methodology, we searched six databases for full-text papers from 2009–2019 published in peer-reviewed journals with no limits on language.ResultsEighteen articles on studies involving 3149 patients from nine countries were identified. Studies were conducted under three broad intervention categories: healthcare professional education (n=1); patient education (n=14) and telemedicine (n=3). Studies were equally focused on prevention and treatment of chronic wounds. Significant improvements were reported in patient knowledge, pain and self-care behaviours. Only two studies evaluated the impact on wound healing and one study estimated the cost of implementing person-centered care.ConclusionsThe evidence base to support PCC in wound management is developing and based on our review has shown improved outcomes in areas of pressure ulcer prevention, patient satisfaction, patient knowledge and quality of life, but clinical outcomes such as wound healing were less well explored. Further research with more objective outcome measures are required.

The purpose of this review was to identify the role and contribution of community-based nurse-led wound care as a service delivery model. Centres increasingly respond proactively to assess and manage wounds at all stages - not only chronic wound care. We conducted an integrative review of literature, searching five databases, 2007-2018. Based on inclusion and exclusion criteria, we systematically approached article selection and all three authors collaborated to chart the study variables, evaluate data, and synthesise results. Eighteen studies were included, representing a range of care models internationally. The findings showed a need for nurse-led clinics to provide evidence-based care using best practice guidelines for all wound types. Wound care practices should be standardised across the particular service and be integrated with higher levels of resources such as investigative services and surgical units. A multi-disciplinary approach was likely to achieve better patient outcomes, while patient-centred care with strong patient engagement was likely to assist patients' compliance with treatment. High-quality community-based wound services should include nursing leadership based on a hub-and-spoke model. This is ideally patient-centred, evidence-based, and underpinned by a commitment to developing innovations in terms of treatment modalities, accessibility, and patient engagement.

Infections are the main reason why most people die from burns and diabetic wounds. The clinical challenge for treating wound infections through traditional antibiotics has been growing steadily and has now reached a critical status requiring a paradigm shift for improved chronic wound care. The US Centers for Disease Control have predicted more deaths from antimicrobial-resistant bacteria than from all types of cancers combined by 2050. Thus, the development of new wound dressing materials that do not rely on antibiotics is of paramount importance. Currently, incorporating nanoparticles into scaffolds represents a new concept of 'nanoparticle dressing' which has gained considerable attention for wound healing. Silver nanoparticles (Ag-NPs) have been categorized as metal-based nanoparticles and are intriguing materials for wound healing because of their excellent antimicrobial properties. Ag-NPs embedded in wound dressing polymers promote wound healing and control microorganism growth. However, there have been several recent disadvantages of using Ag-NPs to fight infections, such as bacterial resistance. This review highlights the therapeutic approaches of using wound dressings functionalized with Ag-NPs and their potential role in revolutionizing wound healing. Moreover, the physiology of the skin and wounds is discussed to place the use of Ag-NPs in wound care into perspective.

Introduction. Chronic wounds pose a widespread challenge to health care, with many new, costly wound care modalities introduced in recent years with varying degrees of success. Bacterial biofilms have been postulated as one of the main culprits of the stagnation of chronic wound healing. For years, surgical fields have used pressurized irrigation for cleansing surgical wounds, but its utility in managing nonhealing chronic wounds has often been overlooked. Objective. In this case series, the authors aimed to demonstrate that hydromechanical therapy with pressurized irrigation can be a cost-effective and clinically effective wound care modality. Materials and Methods. The authors present 6 clinical cases of difficult nonhealing wounds managed with hydromechanical therapy with pressurized irrigation, a follow-up from the initial case report. Other, often more expensive modalities, had previously failed. In all 6 cases, irrigation was performed using tap water or saline either at home or long-term care facilities. Literature that focused on the mechanism of healing from hydromechanical therapy was reviewed. Results. All chronic wounds in the series reached stable healing. The authors speculate that such healing was achieved through biofilm disruption and tissue stimulation with a mechanical impact. Literature supporting this hypothesis is presented. Conclusions. The current clinical results offer a new perspective on the role of a traditional surgical modality of hydromechanical therapy in chronic wound care and on the associated opportunity of potential cost savings.

Chronic wounds can be difficult to heal and are often accompanied by pain and discomfort. Multiple skin substitutes or cellularized/tissue-based skin products have been used in an attempt to facilitate closure of complex wounds. Allografts from cadaveric sources have been a viable option in achieving such closure. However, early assessment of graft incorporation has been difficult clinically, often with delayed evidence of failure. Visual cues to assess graft integrity have been limited and remain largely superficial at the skin surface. Furthermore, currently used optical imaging techniques can penetrate only a few millimeters deep into tissue. Ultrasound (US) imaging offers a potential solution to address this limitation. This work evaluates the use of US to monitor wound healing and allograft integration. We used a commercially available dual-mode (US and photoacoustic) scanner operating only in US mode. We compared the reported wound size from the clinic with the size measured using US in 45 patients. Two patients from this cohort received an allogenic skin graft and underwent multiple US scans over a 110-d period. All data were processed by two independent analysts; one of them was blinded to the study. We measured change in US intensity and wound contraction as a function of time. Our results revealed a strong correlation (R2=0.81, p < 0.0001) between clinically and US-measured wound sizes. Wound contraction >91% was seen in both patients after skin grafting. An inverse relationship between wound size and US intensity (R2=0.77, p < 0 .0001) indicated that the echogenicity of the wound bed increases as healthy cells infiltrate the allograft matrix, regenerating and leading to healthy tissue and re-epithelization. This work indicates that US can be used to measure wound size and visualize tissue regeneration during the healing process.

Multidisciplinary management of chronic wounds using comprehensive wound centers improves outcomes. With an increasing need for wound providers, little is known about surgeons’ roles in wound centers. An online survey of two national surgical organization members covered demographics, wound center characterization, and surgeons’ perspectives of wound centers and wound care. Surgeon perspectives were compared by age, gender, and relationship status. Three hundred sixty-four surgeons responded. Respondents were mostly older than 50 years, male, in practice older than 10 years, and used wound centers. Most respondents reported favorable experiences with wound centers but uncertainty about financial details. Most respondents were interested in formal wound care certification and participation in a wound practice, particularly as a transition to the retirement option for older surgeons. Surgeons are interested in pursuing a career focus in wound care. Further efforts are needed to educate surgeons and create a pathway for surgeons to become wound center directors. In a nationwide survey, surgeon perspectives on wound centers and wound specialization were positive, although financial understanding was limited. The importance of this finding is the support of wound care pathways for surgeons.

Mark Greener details the burden of managing chronic and acute wounds in primary care

Chronic non-healing wounds have become a major worldwide healthcare burden. The impact of biofilms on chronic wound infection is well established. Despite increasing understanding of the underlying mechanism of biofilm formation in chronic wounds, current strategies for biofilm diagnosis in chronic wounds are still far from ideal. In this review, we briefly summarize the mechanism of biofilm formation and focus on current diagnostic approaches of chronic wound biofilms based on morphology, microbiology, and molecular assays. Innovative biotechnological approaches, such as wound blotting and transcriptomic analysis, may further shed light on this unmet clinical need. The continuous development of these sophisticated diagnostic approaches can markedly contribute to the future implementation of point-of-care biofilm detection in chronic wound care.

Ari ve ari urunlerinin tibbi kullanimi tibbin ilk gunlerinden beri merak konusu olmus bir oznedir. Bal, polen, ari sutu (royal jelly), propolis, ari zehri ve bal mumunun hepsi ayri ayri farkli kimyasal yapilara ve etkinlige sahiptir. Balin gerek lokal gerekse de sistemik tibbi kullanim potansiyeli yuksek olsa da, bugun ozellikle plastik cerrahi ve kronik yara bakiminda bal ve balli yara ortuleri rutin kullanimdadir. Farkli iklim kosullari ve farkli cografyalardan elde edilmis dogal ballar uzerine yapilan kontrollu klinik calismalarda, balin asiditesi, hidrojen peroksit icerigi, osmotik etkisi, besleyici ve antioksidan icerikleri ve henuz arastirma safhasinda olan tanimlanmamis diger icerikleri ile doku iyilesmesini hizlandirici, epitelizasyonu arttirici, antibakteriyel etki gosteren, bagisikligi uyaran ve skar formasyonunu azaltici etkileri oldugu ortaya konmustur. Ancak bir sorun vardir ki balin farmakolojik aktivitesi, potensi ve icerigi; cografya, mevsim, balin gordugu islem, depolama ve ari turune gore degismektedir. Ayrica balin kontaminasyon riski de ayri bir sorundur. Bu nedenle her balin tibbi kullanima uygunlugu dillendirilememekte ve ballarin tibbi kullanimdan once ozel islemlerden gecmesi gerekmektedir.

Aim To determine the impact of advanced practice nurses in chronic wound care in the adequacy of treatments for patients with chronic wounds and the consumption of dressings in the districts where they have been implemented. Method A quasi-experimental pre-poststudy without a control group with 3 measurements: pre-implementation in 2015, one year after implementation in 2016, and 2 years post-implementation in 2017, in the health districts (HD) where the role of the advanced practice nurse in chronic wound care was piloted in Andalusia. The main variables were trained professionals, consultancies, prevalence of chronic wounds, adequacy of treatments and economic cost in materials for the participating HD. Results The training of a total of 2717 health teams with a total of 95,095 teaching hours was achieved. In addition, a total of 3871 consultancies were performed. The prevalence of patients with injuries in the home care (HC) programme and in care homes diminished significantly, to almost half. The adequacy of the treatments increased to 90% and savings of more than 250,000€ in dressings were achieved in just 2 years. Conclusion The prevalence of chronic wounds during the 2 years of implementation decreased by almost half. Adequacy of training and consultancy was achieved, rationalising health expenditure and ensuring efficient care for patients with chronic wounds.

Chronic wounds (CWs) usually happen in diabetic foot ulcers, venous leg ulcers, and pressure ulcers. When wounds fail to achieve sufficient healing within four weeks, it indicates that bacteria in the wounds are promoting chronicity through relapse infections. Therefore, how to observe changes in a wound after it is covered with gauze to avoid the formation of CWs is important for clinical care. Previous studies showed that wound pH value distribution can be used as an important basis for infection and healing assessment. This paper proposed the design of sensor gauze with multi-channel moisture and pH monitoring for CWs. The moisture sensing analysis of different areas could be used to determine the distribution of the corresponding wound tissue fluid, as well as automatically carry out multi-area pH value measurements and wound analysis. The analysis results were graphically displayed on a monitoring device. The results indicated that the proposed design could measure pH values with high sensitivity (0.01 pH/mV) in the range of 3 to 10. Statistical correlation analysis revealed a strong correlation ( $R^{2} = 0.97$ ) between the standard meter and each pH sensing point. In the experimental correlation between the proposed device and the moisture device, the results show that there was a high correlation ( $R^{2} = 0.97$ ). The response time of the whole wound scan with four channels was within one second. This design has the potential to provide assistance for related clinical care applications.

An inability of the human body to heal acute wounds under certain conditions results in the formation of chronic ulcers. Chronic wounds not only cause significant pain and discomfort for patients but also serve as an entry for microorganisms into the human body, which can result in serious life-threatening problems and become a significant burden for the patients and society. The current work present results of a multicentre prospective observational study demonstrating the use of a lyophilized amniotic membrane (AM) in the treatment of chronic wounds (various etiologies). Lyophilized AM produced under the commercial brand Amnioderm® was used as an allograft material for therapy of chronic wounds, in addition to chronic ulcer standard-of-care (SoC) protocols. The duration of wounds considered for the application of AM ranged between 2 months and 11 years. In total, 16 patients were enrolled to the study, of which eight were completely healed, six demonstrated a significantly reduced ulcer size, and two did not respond to the AM therapy. The current study unambiguously demonstrates an effective alternative to the standard of chronic wound care and confirms a significant effect of the AM application for chronic wound management as a new SoC.

Vascular assessment is a critical component of wound care. Current routine noninvasive vascular studies have limitations which can give a false sense of security of the presence of adequate perfusion for healing. Near-infrared imaging modalities can serve as an additional diagnostic assessment of wounds in which adequate perfusion is a concern. Correct interpretation of near-infrared images obtained is critical as subtleties that exist in the acute and chronic wound population goes beyond the interpretation that increased signal is consistent with adequate perfusion for healing. The objective of this paper is to educate providers on the correct interpretation of this point-of-care imaging modality in day-to-day wound-care practice to guide clinical decision-making for rapid wound resolution.

Chronic wounds caused by infections, diabetes, and radiation exposures are becoming a worldwide growing medical burden. Recent progress highlighted the physical signals determining stem cell fates and bacterial resistance, which holds potential to achieve a better wound regeneration in situ. Nanoparticles (NPs) would benefit chronic wound healing. However, the cytotoxicity of the silver NPs (AgNPs) has aroused many concerns. This review targets the tunable physical properties (i.e., mechanical-, structural-, and size-related properties) of either dermal matrixes or wound dressings for chronic wound care. Firstly, we discuss the recent discoveries about the mechanical- and structural-related regulation of stem cells. Specially, we point out the currently undocumented influence of tunable mechanical and structural properties on either the fate of each cell type or the whole wound healing process. Secondly, we highlight novel dermal matrixes based on either natural tropoelastin or synthetic elastin-like recombinamers (ELRs) for providing elastic recoil and resilience to the wounded dermis. Thirdly, we discuss the application of wound dressings in terms of size-related properties (i.e., metal NPs, lipid NPs, polymeric NPs). Moreover, we highlight the cytotoxicity of AgNPs and propose the size-, dose-, and time-dependent solutions for reducing their cytotoxicity in wound care. This review will hopefully inspire the advanced design strategies of either dermal matrixes or wound dressings and their potential therapeutic benefits for chronic wounds.

A gap in treatment options exists in diabetic wound healing, often resulting in severe consequences, including amputation for patients who suffer from these chronic wounds. Microannealed particle gel (MAP gel), specifically loaded with Epidermal Growth Factor (EGF), provides an environment that is suitable for tissue integration and vascularization for healing of these complex wounds. In preparing for the availability of this alternative medical treatment, the human and social dimensions of the technology must be considered to ensure that all people, regardless of socioeconomic background, have access to it to prevent disparities in quality of care. The STS theories of techno-politics, which addresses how policies develop around technologies and create positive and negative power dynamics, and inclusive innovation can be applied to analyze the human and social dimensions of developing a new diabetic wound healing treatment. In order to analyze whether there is a current disparity in the quality of diabetes care for those who face financial insecurities as well as understand the important considerations to bring a new medical treatment to the marketplace, data from the CDC on the cost of diabetes care in each state across the country will be compared to the range of wealth for residents of each state. In addition, interviews with diabetes advocacy groups in Washington D.C. will allow for an understanding of the personal and daily implications of the cost and disparities of care. Gaps in quality of care for diabetic patients due to their differences in financial standing will be uncovered and analyzed. Through the unison of predicting the social implications of a new healthcare treatment and the development of a technology that fills an apparent gap in the diabetic care space, many patients’ qualities of life stand to be dramatically improved.

Aim: Complementary medicinal techniques have gainedfocus by modern medicine, recently. Maggot Debridement Therapy is a widely-used method worldwide. It is especially recommended for chronic wounds, and has serious advantages such as low cost, easily-applicability and rare adverse effects, but its effect mechanisms remains unclear. The aim of this study is to detect components and to investigate potential antibacterial effects of whole body extract metabolites of Lucilia sericata larvae.Material anf Methods: Due to potential antibacterial effects, agar well diffusion and flowcytometry methods were used against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Enterococcus faecalis to do evaluation on whole body extracts of previously-cloned maggots in specialized climate room. After this antibacterial effect evaluation, 2-D PAGE analysis was done for protein investigation. Results: Inhibition zones were observed for S.aureus (16mm), E.coli (22mm) and E.faecalis (14mm), but for P.aeruginosa, the extract could not provide any inhibiton zone. In flow cytometry, different killing rates were detected in different extract dilutions, and for the lowest (1/64) dilution, killing rates were 51.9%, 75%, 80% and 98.7% for P.aeruginosa, E.faecalis, E.coli and S.aureus, respectively. 2-D PAGE showed various proteins with different molercular mass (

Wound care management relies mainly on the development of new and effective wound dressing materials, and it continues to be an intense area of research in chronic wound care. Proper wound care management is a significant clinical challenge and there is a growing need for wound care. In recent years, the research and development of wound dressing materials have entered a new level of standards and there is a far better understanding based on the pathogenesis of chronic wounds. Nanotechnology offers a superlative approach to hasten the healing of acute and chronic wounds, by stimulating proper movement through the different healing phases. In nanotechnology, the small sized nanomaterials, nanoscaffolds, nanofibers and biomaterials are used for topical drug delivery for wound healing. In recent years, the use of nanomaterials for biomedical and pharmaceutical applications have gained significant attraction. Thus, a considerable percentage of nanomaterials are used in various biomedical applications for wound dressings, drug delivery and other medical purposes. This review is an attempt to illustrate the use of nanoparticles and biodegradable nanomaterials in wound healing. Additionally, the present status of nanoparticles delivery of exogenous growth factors and peptide structures in clinical trials are also reviewed in this manuscript.

Topical silver agents and dressings are used to control infection and promote healing in chronic wounds, but reviews published from 2006 to 2011 found heterogeneous results regarding their effectiveness. A scoping review was conducted to examine the extent, range, and nature of research activity surrounding chronic wound care that employed silver-impregnated dressings; identify research gaps in the existing literature; and summarize the evidence to provide recommendations for future clinical studies. Ten (10) electronic databases and additional sources were screened from their inception to May 2016; search terms for the different databases included but were not limited to silver, chronic, complications, wound, ulcer, and sore. English-language articles that compared silver dressings with an alternate treatment in adults with chronic wounds and that reported clinical outcome measures were included. Of 222 full-text reviewed studies, 27 were included for qualitative analysis. Qualitative analysis was guided by key findings identified among the included studies that were analyzed in aggregate form where appropriate. In comparative analyses of the 26 studies that investigated wound healing, 15 revealed significantly positive wound healing outcomes with silver treatments versus 9 that did not; the remaining 2 failed to provide statistical values of significance. Of 17 studies that presented data on microbiology, 3 reported significant microbial load improvement for silver dressings, 9 noted nonsignificant findings, and 4 provided no statistical values. Pain, adverse events, and treatment cost were included in 5, 7, and 3 studies, respectively, with heterogeneous findings. The heterogeneous evidence regarding the impact of silver dressings on clinical outcomes may be related to differences in the silver treatments themselves, heterogeneous intervention strategies, study designs, outcomes, and measures. Well-designed clinical studies with multiple outcome parameters are necessary to determine the optimal type and use of silver-dressings in chronic wounds.

Nonhealing wounds pose a major challenge in clinical medicine. Typical chronic wounds, such as diabetic foot ulcers and venous leg ulcers, have brought substantial difficulties to millions of patients around the world. The management of chronic wound care remains challenging in terms of precise wound size measurement, comprehensive wound assessment, timely wound healing monitoring, and efficient wound case management. Despite the rapid progress of digital health technologies in recent years, practical smart wound care management systems are yet to be developed. One of the main difficulties is in-depth communication and interaction with nurses and doctors throughout the complex wound care process. This paper presents a systematic approach for the user-centered design and development of a new smart mobile system for the management of chronic wound care that manages the nurse’s task flow and meets the requirements for the care of different types of wounds in both clinic and hospital wards. The system evaluation and satisfaction review was carried out with a group of ten nurses from various clinical departments after using the system for over one month. The survey results demonstrated high effectiveness and usability of the smart mobile system for chronic wound care management, in contrast to the traditional pen-and-paper approach, in busy clinical contexts.

Objective To determine the feasibility of a piloted wound care curriculum within a busy internal medicine (IM) curriculum. Methods This prospective pilot study was conducted with 89 IM residents at an academic teaching hospital. The residents were provided a 90-minute workshop in chronic wound care. They anonymously completed a clinical vignette to target practice behavior prior to the workshop. The workshop was mixture of didactic and hands-on practice of sharp debridement and wound dressing selection. Three months later, the residents completed the same clinical vignette along with questions on changes and barriers to change in their practice. Main outcome measures Change in behavior of chronic wound care management, measurements of barriers to change in participant continuity clinics. Main results Of the participants, 57 residents (64%) and 25 residents (28%) completed a pre- and postvignette, respectively. Ten (40%) of the postvignette respondents stated that they had made changes in their care. Barriers to change included having a supervising attending physician who is not comfortable with wound care, a lack of wound care resources available in clinic, and a lack of confidence even after the session. Conclusions It is feasible to insert a chronic wound care education into a busy IM curriculum. Future efforts will be aimed at assessing the wound care needs/resources of the IM outpatient clinics, addressing the comfort of the supervising attending physicians and residents with wound care, and focusing the curriculum on high-yield interventions.