Richard Salcido

More than one way to measure a wound: an overview of tools and techniques.

PURPOSE To improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participant’s understanding of the tools and techniques available for wound measurement. TARGET AUDIENCE This CME/CE activity is intended for physicians and nurses with an interest in learning about tools and techniques available for wound measurement. OBJECTIVES After reading the article and taking the test, the participant will be able to: Identify advantages and disadvantages of various dimensional methods used to measure wounds.Identify advantages and disadvantages of visual and photographic assessment methods.Identify advantages and disadvantages of vascular and pressure assessment methods.

Health Professional's Guide to Rehabilitation of the Patient with Osteoporosis

This guide is a summary reference on the rehabilitation principles that should be applied in the treatment and prevention of osteoporosis. As this guide addresses primarily rehabilitation issues required by osteoporotic fracture or low bone mass, the health professional is directed to the National Osteoporosis Foundation’s companion piece, Physician’s Guide to Prevention and Treatment of Osteoporosis (‘Physician’s Guide’), for other treatment approaches. Rehabilitation and exercise are often viewed as a means to improve function, such as activities of daily living (ADL) for patients. Psychosocial factors also impact strongly on functional ability and the general health of the osteoporotic patient. The information in this guide is based on scientific evidence from basic research, consensus from an expert panel convened by the National Osteoporosis Foundation (NOF), clinical studies, and randomized controlled clinical trials. The small number of randomized trials points to the need for more of them in the future. The majority of the studies on rehabilitation approaches and exercise recommendations related to osteoporosis are based on studies among white perimenopausal women. Clearly, osteoporosis affects men and non-white women as well. It can also affect younger as well as older individuals with certain chronic conditions and medication use. Until we have additional data, recommendations for these other populations should be on an individual basis. The committee believes that the guidelines have universal application in terms of recommending life-long, safe activities and exercises for all people. This guide’s recommendations are not intended as rigid standards of practice, but must be tailored for use by physicians in consultation with their patients. Executive Summary

The clinical relevance of microbiology in acute and chronic wounds.

PURPOSEnTo improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participants understanding of how wound microbiology affects healing.nnnTARGET AUDIENCEnThis CME/CE activity is intended for physicians and nurses with an interest in interpreting the role of microorganisms in wound healing.nnnOBJECTIVESnAt the conclusion of this course, participants should be able to: 1. Identify the microbiology of acute and chronic wounds, risk factors for infection, and advantages and disadvantages of wound culturing. 2. Identify methods of debridement and wounds for which they are appropriate. 3. Identify systemic antibiotic treatment options for acute and chronic wound infections.

Animal Models in Pressure Ulcer Research

Abstract Background/Objective: Research targeting the pathophysiology, prevention, and treatment of pressure ulcers (PrUs) continue to be a significant priority for clinical and basic science research. Spinal cord injury patients particularly benefit from PrU research, because the prevalence of chronic wounds in this category is increasing despite standardized medical care. Because of practical, ethical, and safety considerations, PrUs in the human environment are limited to studies involving patients with pre-existing ulcers. Therefore, we are limited in our basic knowledge pertaining to the development, progression, and healing environment in this devastating disease. Methods: This review provides a synopsis of literature and a discussion of techniques used to induce PrUs in animal models. The question of what animal model best mimics the human PrU environment has been a subject of debate by investigators, peer review panels, and editors. The similarities in wound development and healing in mammalian tissue make murine models a relevant model for understanding the causal factors as well as the wound healing elements. Although we are beginning to understand some of the mechanisms of PrU development, a key dilemma of what makes an apparently healthy tissue develop a PrU waits to be solved. Results and Conclusions: No single method of induction and exploring PrUs in animals can address all the aspects of the pathology of chronic wounds. Each model has its particular strengths and weaknesses. Certain types of models can selectively identify specific aspects of wound development, quantify the extent of lesions, and assess outcomes from interventions. The appropriate interpretation of these methods is significant for proper study design, an understanding of the results, and extrapolation to clinical relevance.

Pilot study of a 360-degree assessment instrument for physical medicine & rehabilitation residency programs.

Musick DW, McDowell SM, Clark N, Salcido R: Pilot study of a 360-degree assessment instrument for physical medicine and rehabilitation residency programs. Am J Phys Med Rehabil 2003;82:394-402. Objective To perform a pilot test on a new format for multidisciplinary assessment of resident physicians’ professionalism and clinical performance in acute inpatient rehabilitation settings. Design In this pilot study, a 26-item ratings instrument was developed for use by therapists, nurses, social workers, case managers, and psychologists to rate inpatient residents. Results A total of 421 ratings forms were returned over four academic years. Alpha reliability coefficient for instrumentation sample was 0.99. &khgr;2 and analysis of variance procedures examined item mean differences. Significant differences (P ≤ 0.05) were found based on resident sex (17 items) and rotation setting (20 items). No significant differences were found based on rater profession; mean ratings by profession ranged from 6.67 (physical therapists) to 7.46 (case managers). Conclusions Psychometric properties of this new ratings format are encouraging. The tool was a useful way to provide formative feedback to residents regarding professionalism and performance. Residency program directors can use this approach to fulfill Accreditation Council for Graduate Medical Education mandates to use a variety of assessment methods regarding resident education. However, potential sex bias and other issues affecting performance ratings should be considered in interpreting results and warrant further study.

Wound pain: a challenge for the patient and the wound care specialist.

PURPOSETo provide physicians and nurses with an overview of the mechanisms, pathophysiology, assessment, and treatment of pain related to pressure ulcers. TARGET AUDIENCEThis continuing education activity is intended for physicians and nurses with an interest in learning about management of patients with pressure ulcer-related pain. LEARNING OBJECTIVESAfter reading the article and taking the test, the participant will be able to:1. Describe the mechanisms and pathophysiology of pain related to pressure ulcers.2. Identify assessment parameters and treatment options for pain related to pressure ulcers.

The Erdman therapy: a treatment utilizing hot and cold therapy.

Applying therapeutic heat and cold is a common practice in physical medicine and rehabilitation. Despite its widespread use, however, relatively little is understood empirically or theoretically about why certain patients benefit from either hot or cold therapy for acute ailments or chronic conditions. Lacking an evidence base, hot and cold therapy is mostly a trial-anderror process. The medical literature reveals that therapeutic heat and cold has been used to treat a variety of clinical conditions, most notably with patients suffering sports-related injuries and arthritic conditions (e.g., rheumatoid arthritis) and joint disorders (e.g., neck, back pain). Recognizing in advance who would benefit from which modality, and who might be harmed, would represent a major step forward in understanding the mechanism and efficacy of therapeutic heat and cold. An obscure, virtually unknown therapy in use for almost a century— known as the Erdman therapy—may yield insight into why some patients are helped by therapeutic heat and cold modalities. The basic premise of the Erdman therapy hypothesizes that patient groups respond to heat vs. cold therapy on the basis of arterial “tone”—the elastic qualities of the smooth muscles in the vessel walls. Arterial tone, in turn, heavily influences the rate of blood flow, and practitioners of this therapy consider blood flow the primary factor in maintaining good health. Using measurements of the rate of blood flow and arterial tone, the Erdman therapy suggests that the use of therapeutic heat and cold can be used to relieve discomfort and even reverse certain illnesses and conditions. Based on use of this therapy by trained practitioners, it is estimated that between 5% and 10% of the general population responds best to cold therapy and the rest to heat therapy. Practitioners have developed an indicator device—the Erdman indicator—to identify the two classes of patients. The theory supporting the categorization structure and its practical application has not been scientifically proven using traditional strength of

Secondary conditions: Crosscutting breakout session

Pain as a Secondary Condition to Disability, Mark P. Jensen, PhD Professor, Department of Rehabilitation Medicine, University of Washington Wound Care: State of the Art from Bench to Bedside, Richard Salcido, MD Professor and Chair of Rehabilitation Medicine; Director of Rehabilitation Services; Senior Fellow, Institute on Aging; Associate, Institute for Medical Bioengineering, University of Pennsylvania School of Medicine and Health System Bladder and Bowel Function and Aging with Physical Disabilities, Graham H. Creasey, MD, FRCSEd Research Physician, Louis Stokes VA Medical Center; Associate Professor, Department of Physical Medicine and Rehabilitation, Case Western Reserve University Prevalence of Obesity among Adults with Disabilities, James H. Rimmer, PhD Professor and Director, Center on Health Promotion Research for Persons with Disabilities, National Center on Physical Activity and Disability, University of Illinois at Chicago