Improved Communication Facilitates Chronic Wound Care for Patients, Families, and Professionals
Notice bibliographique
Résumé
November is family caregiver recognition month in the US.1 This is an ideal time to reflect on skin and wound care challenges faced by our patients and their families. Implementation of the Caregiver Advise Record Enable (CARE) Act has resulted in an urgent call for professionals to facilitate care through enhanced communication and patient/caregiver education. We need to use this opportunity to develop new ways to partner with our patients and their families, especially when wounds are not healing at the expected rate.2–4 This month’s CE/CME article provides a framework or supporting structure to systematically review and optimize care for persons with nonhealing wounds. This framework could evolve into a useful checklist if the items are validated as compulsory criteria to establish a healing trajectory. The components of the framework can be divided into the Wound Bed Preparation model, including patient-centered concerns along with the treatment of the cause, ability to heal, and local wound care.5 Patient-centered concerns revolve around pain, activities of daily living, and the patients’ circle of care. If pain is categorized on an 11-point numerical rating scale (0–10, where 0 is no pain), most patients can live with a pain level of 3 or 4 and carry out activities of daily living. Wound care providers need to take coresponsibility for care negotiated with the patient and his or her circle of care. For example, patients with pain should be offered options for treating both nociceptive and neuropathic pain with adjustable medications and diversional therapies. An adequate support network can facilitate attendance at healthcare appointments, good nutrition, adherence to treatment, and a clean home environment. Most wound care professionals agree that persons with chronic wounds can present with a variety of comorbidities and factors that can impact on wound healing. The complexity of these cases requires care coordination and communication to facilitate a mutually agreeable plan of care. Wounds that are not in a healing trajectory especially require a comprehensive assessment (ideally with an interprofessional team) to establish a precise diagnosis and identify modifying factors that may or may not be correctable.6 These assessments should involve the “whole patient” and not only the “hole in the patient!” In addition to vascular function, the CE/CME discusses a number of other variables that can delay healing: Suboptimal nutrition corrected with dietary counseling and healthy eating Smoking tobacco with counseling to reduce or stop Inadequate diabetes control optimized with hemoglobin A1c as close to 7 as possible Abnormal laboratory studies (low hemoglobin, impaired liver and kidney function) Other coexisting diseases (rheumatoid arthritis, malignancy) or drugs (steroids, immunosuppressive agents) that can impair healing Clinical signs of infection that need to be treated with antimicrobial therapy Outlining key factors to consider facilitates interprofessional team communication and ultimately potentially enhances treatment. Ideally, we can heal most wounds with a framework for improved diagnosis, identification of modifiable factors, and evaluation of patient response to the treatment. The quality of life can also be improved for patients with nonhealable wounds by addressing patient-centered concerns and concentrating on the needs of the whole person.FigureR. Gary Sibbald, BSc, MD, DSc (Hons), MEd, FRCPC (Med Derm), FAAD, MAPWCA, JMFigureElizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».