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Auteur Karen K. Evans
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Ajouter le résultat dans votre panier Affiner la rechercheEnsuring Quality Care in the COVID-19 Era Applying the Donabedian Model to Tertiary Wound Care Center Practices / Karen K. Evans in Journal of the American Podiatric Medical Association, vol. 113, 02 (Mars 2023)
[article]
in Journal of the American Podiatric Medical Association > vol. 113, 02 (Mars 2023)
Titre : Ensuring Quality Care in the COVID-19 Era Applying the Donabedian Model to Tertiary Wound Care Center Practices Type de document : article de périodique Auteurs : Karen K. Evans ; Jenna C. Bekeny ; Elizabeth G. Zolper ; John S. Steinberg ; Jayson Atves ; Carol Deane Benedict ; Kenneth L. Fan ; Cameron M. Akbari ; Christopher Attinger Année de publication : 2023 Langues : Anglais (eng) Descripteurs (mots clés) : [Thésaurus Mesh]Cicatrisation de plaie
[Thésaurus Mesh]COVID-19
[Thésaurus Mesh]Pied diabétique
[Thésaurus Mesh]Plaies et blessures
[Thésaurus Mesh]Qualité des soins de santéMots-clés : modèle Donabedian Résumé : The coronavirus disease of 2019 pandemic has disrupted health care, with its far-reaching effects seeping into chronic disease evaluation and treatment. Our tertiary wound care center was specially designed to deliver the highest quality care to wounded patients. Before the pandemic, we were able to ensure rapid treatment by means of validated protocols delivered by a colocalized multidisciplinary team within the hospital setting. The pandemic has disrupted our model’s framework, and we have worked to adapt our workflow without sacrificing quality of care. Using the modified Donabedian model of quality assessment, we present an analysis of prepandemic and intrapandemic characteristics of our center. In this way, we hope other providers can use this framework for identifying evolving problems within their practice so that quality care can continue to be delivered to all patients Permalink : https://bibliotheque.helb-prigogine.be/opac_css/index.php?lvl=notice_display&id= [article]Exemplaires
Cote Support Localisation Section Disponibilité aucun exemplaire A Focus on Amputation Level: Factors Preventing Length Preservation in the National Inpatient Sample / Kenneth L. Fan in Journal of the American Podiatric Medical Association, vol. 112, 01 (Janvier - mars 2022)
[article]
in Journal of the American Podiatric Medical Association > vol. 112, 01 (Janvier - mars 2022)
Titre : A Focus on Amputation Level: Factors Preventing Length Preservation in the National Inpatient Sample Type de document : article de périodique Auteurs : Kenneth L. Fan ; Jenna C. Bekeny ; Christopher Kennedy ; Elizabeth G. Zolper ; John S. Steinberg ; Christopher Attinger ; Karen K. Evans ; Derek DeLia Année de publication : 2022 Langues : Anglais (eng) Descripteurs (mots clés) : [Thésaurus Mesh]Amputation chirurgicale
[Thésaurus Mesh]Cheville
[Thésaurus Mesh]Genou
[Thésaurus Mesh]Mortalité
[Thésaurus Mesh]Pied diabétique
[Thésaurus Mesh]Ulcère du pied
[Thésaurus HELB]:Paramédical:Avant piedRésumé : Background: Diabetic lower-extremity disease is the primary driver of mortality in patients with diabetes. Amputations at the forefoot or ankle preserve limb length, increase function, and, ultimately, reduce deconditioning and mortality compared with higher-level amputations, such as below-the-knee amputations (BKAs). We sought to identify risk factors associated with amputation level to understand barriers to length-preserving amputations (LPAs).
Methods: Diabetic lower-extremity admissions were extracted from the 2012-2014 National Inpatient Survey using ICD-9-CM diagnosis codes. The main outcome was a two-level variable consisting of LPAs (transmetatarsal, Syme, and Chopart) versus BKAs. Logistic regression analysis was used to determine contributions of patient- and hospital-level factors to likelihood of undergoing LPA versus BKA.
Results: The study cohort represented 110,355 admissions nationally: 42,375 LPAs and 67,980 BKAs. The population was predominantly white (56.85%), older than 50 years (82.55%), and male (70.38%). On multivariate analysis, living in an urban area (relative risk ratio [RRR] = 1.48; P < .0001) and having vascular intervention in the same hospital stay (RRR = 2.96; P < .0001) were predictive of LPA. Patients from rural locations but treated in urban centers were more likely to receive BKA. Minorities were more likely to present with severe disease, limiting delivery of LPAs. A high Elixhauser comorbidity score was related to BKA receipt.
Conclusions: This study identifies delivery biases in amputation level for patients without access to large, urban hospitals. Rural patients seeking care in these centers are more likely to receive higher-level amputations. Further examination is required to determine whether earlier referral to multidisciplinary centers is more effective at reducing BKA rates versus satellite centers in rural localities.Permalink : https://bibliotheque.helb-prigogine.be/opac_css/index.php?lvl=notice_display&id= [article]Exemplaires
Cote Support Localisation Section Disponibilité aucun exemplaire Utility of Porcine-Derived Xenograft as an Adjunct to SplitThickness Skin Grafting in Lower-Extremity Wounds / Jenna C. Bekeny in Journal of the American Podiatric Medical Association, Vol. 111, 03 (Mai-juin 2021)
[article]
in Journal of the American Podiatric Medical Association > Vol. 111, 03 (Mai-juin 2021)
Titre : Utility of Porcine-Derived Xenograft as an Adjunct to SplitThickness Skin Grafting in Lower-Extremity Wounds Type de document : article de périodique Auteurs : Jenna C. Bekeny ; Christopher Kennedy ; Jon D. Turissini ; Iram Naz ; Elliot T. Walters ; Paul Kim ; Karen K. Evans ; John Steinberg ; Christopher Attinger ; Tammer Elmarsafi Année de publication : 2021 Langues : Anglais (eng) Descripteurs (mots clés) : [Thésaurus Mesh]Pansements biologiques
[Thésaurus Mesh]Pied
[Thésaurus Mesh]Plaies et blessures
[Thésaurus Mesh]Transplantation hétérologueRésumé : Objective: Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods: Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30- and 60-day outcomes were collected. Results: There was no difference in healing outcomes between the PXBD (n ¼ 27) and no preparation (n ¼ 39) groups. At 30- and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P30 ¼ .818; 82.2% versus 80.9%, P60 ¼ .422). Mean wound sizes at these follow-up periods were not different (4.4 cm2 versus 5.1 cm2, P30 ¼ .902; 1.2 cm2 versus 1.1 cm2, P60 ¼ .689). The PXBD group had a higher mean 6 SD hemoglobin A1c level (8.3 6 3.5 versus 6.9 6 1.6; P ¼ .074) and age (64.9 6 12.8 years versus 56.3 6 11.9 years; P ¼ .007) versus the no preparation group. Conclusions: Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct. Permalink : https://bibliotheque.helb-prigogine.be/opac_css/index.php?lvl=notice_display&id= [article]Exemplaires
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