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Biomedical subjects

G Rodeheaver

Publications and source records attributed to G Rodeheaver.

At least 19 recordsLinked to original sources
PubMed2001

Quality of care for hospitalized medicare patients at risk for pressure ulcers.

BACKGROUND: No state peer review organization has attempted to identify processes of care related to pressure ulcer prediction and prevention in US hospitals. OBJECTIVE: To profile and evaluate the processes of care for Medicare patients hospitalized at risk for pressure ulcer development by means of the Medicare Quality Indicator System pressure ulcer prediction and prevention module. METHODS: A multicenter retrospective cohort study with medical record abstraction was used to obtain a total of 2425 patients aged 65 years and older discharged from acute care hospitals after treatment for pneumonia, cerebrovascular disease, or congestive heart failure. Six processes of care for prevention of pressure ulcers were evaluated: use of daily skin assessment; use of a pressure-reducing device; documentation of being at risk; repositioning for a minimum of 2 hours; nutritional consultation initiated for patients with nutritional risk factors; and staging of pressure ulcer. The associations between processes of care and incidence of pressure ulcer were determined with Kaplan-Meier survival analyses. RESULTS: National estimates of compliance with process of care were as follows: use of daily skin assessment, 94%; use of pressure-reducing device, 7.5%; documentation of being at risk, 22.6%; repositioning for a minimum of 2 hours, 66.2%; nutritional consultation, 34.3%; stage 1 pressure ulcer staged, 20.2%; and stage 2 or greater ulcer staged, 30.9%. CONCLUSION: These results suggest that US hospitals and physicians have numerous opportunities to improve care related to pressure ulcer prediction and prevention.

Age Distribution↗
PubMed1995

The chronic wound care clinic: "one-stop shopping".

The principal goals of wound management are the provision of effective care and cost containment. An outpatient clinic dedicated to the management of chronic wounds offers several advantages over traditional, more fragmented approaches. The Chronic Wound Care Clinic at the University of Virginia Health Sciences Center, a multidisciplinary outpatient clinic, provides "one-stop shopping," allowing patients to benefit from coordinated care provided in a single setting. Overviews of the clinic's history, philosophy, and structure are presented. A case study illustrates the rapid wound healing and cost savings of one patient cared for at the clinic.

Adult↗
PubMed1994

Definitions and guidelines for assessment of wounds and evaluation of healing.

Chronic wounds represent a worldwide problem. For laboratory and clinical research to adequately address this problem, a common language needs to exist. This language should include a system of wound classification, a lexicon of wound descriptors, and a description of the processes that are likely to affect wound healing and would healing end points. The report that follows defines wound, acute wound, chronic wound, healing and forms of healing, wound assessment, wound extent, wound burden, and wound severity. The utility of these definitions is demonstrated as they relate to the healing of a skin wound, but these definitions are broadly applicable to all wounds.

Journal Article↗
PubMed1994

Wound healing and wound management: focus on debridement. An interdisciplinary round table, September 18, 1992, Jackson Hole, WY.

A multidisciplinary panel of experts convened to discuss the basic concepts of prevention and treatment of pressure ulcers. Special emphasis was placed on four types of debridement: mechanical, surgical, autolystic, and enzymatic. Debridement of burns was also discussed. Team management by informed practitioners is vital to successful wound care and all treatments should be based on a holistic appraisal of patients and their individualized plans of care.

Debridement↗
PubMed1994

Definitions and guidelines for assessment of wounds and evaluation of healing.

BACKGROUND: Chronic wounds represent a worldwide problem. For laboratory and clinical research to adequately address this problem, a common language needs to exist. OBSERVATION: This language should include a system of wound classification, a lexicon of wound descriptors, and a description of the processes that are likely to affect wound healing and wound healing end points. CONCLUSIONS: The report that follows defines wound, acute wound, chronic wound, healing and forms of healing, wound assessment, wound extent, wound burden, and wound severity. The utility of these definitions is demonstrated as they relate to the healing of a skin wound, but these definitions are broadly applicable to all wounds.

Acute Disease↗
PubMed1984

Quantitation of skin-flap survival: a computer-based method.

We have proposed a standard scheme for presenting data on experimental skin flap survival in pharmacologic studies that will aid in comparing results. In addition, we have presented a method using desktop computer accessories for accurately measuring the area of any flap.

Animals↗
PubMed1983

Evaluation of aztreonam in experimental bacterial meningitis and cerebritis.

Aztreonam (SQ 26,776), a new monocyclic beta-lactam agent, was compared with ampicillin, ampicillin plus chloramphenicol, and gentamicin in rabbits with experimental meningitis induced by, respectively, ampicillin-susceptible Haemophilus influenzae, ampicillin-resistant H. influenzae, and Escherichia coli. Aztreonam was also compared with gentamicin in experimentally induced E. coli cerebritis in rats. Doses of the various agents were delivered that produced near-peak concentrations in serum comparable to those attained in humans on standard parenteral regimens. The percent penetration [( concentration in cerebrospinal fluid/concentration in serum] X 100) of aztreonam into purulent rabbit cerebrospinal fluid was 23% (versus 12, 27, and 21%, respectively, for ampicillin, chloramphenicol, and gentamicin). In experimental meningitis in vivo, aztreonam was more rapidly bactericidal than was ampicillin in ampicillin-susceptible H. influenzae meningitis, ampicillin or chloramphenicol in ampicillin-resistant H. influenzae meningitis, or gentamicin in E. coli meningitis. In the therapy of experimental cerebritis, the early stage of brain abscess formation, aztreonam reduced the numbers of E. coli in rat brain as rapidly as did gentamicin. Aztreonam deserves further evaluation in acute gram-negative bacterial infections of the central nervous system in both experimental animals and in humans.

Animals↗
PubMed1982

Bactericidal activity and toxicity of iodine-containing solutions in wounds.

Complexing iodine with povidone (polyvinylpyrrolidone) or surfactants significantly limits the quantity of free iodine. Reduction of the free iodine level eliminates the adverse properties of staining, instability, and irritation and also alters bactericidal activity. Addition of detergents to create surgical scrub solutions further reduces the activity of iodine. In vitro testing indicated that the bactericidal activity of iodophors was inferior to that of uncomplexed aqueous iodine. In vivo tests proved that aqueous iodine significantly potentiated the development of infection. Although the povidone iodophor did not enhance the rate of wound or infection, it offered no therapeutic benefit when compared with control wounds treated with saline solution. Addition of detergents to the povidone iodophor was deleterious, with the wounds exposed to this combination displaying significantly higher infection rates than untreated control wounds. Based on these results, aqueous iodine solutions and iodophor surgical scrub solutions should not be used on broken skin. Aqueous iodophors can be used in wounds, but no therapeutic benefit from such use was found in this study.

Animals↗
PubMed1981

Age as a critical factor in the success of surgical correction of craniosynostosis.

The effect of timing of the surgical release of prematurely immobilized coronal sutures was studied in rabbits. At 9 days of age, the coronal suture was mechanically immobilized by the application of methyl cyanoacrylate adhesive. These animals and a control group then received metallic implants on each side of the suture to monitor growth. At 30, 60, or 90 days after suture immobilization, separate groups of animals underwent a linear suturectomy to release the restriction. In animals in which the suture was not released, growth at the coronal suture was significantly restricted and resulted in severe deformities in the neurocranium. The benefits derived from surgical release were time-dependent. Suturectomy at 30 days of age resulted within 60 days in achievement of 100% of the growth in sham-treated controls. In contrast, delayed surgery at 60 or 90 days of age resulted in achievement of only 38% and 17% of normal growth, respectively. Angular measurements of the vault and base of the cranium showed a similar graded response toward normality, with the greatest correction occurring with the earliest operation. These results support the clinical impression that early surgical correction of craniosynostosis results in superior cosmetic appearance. A further implication of this work is that abnormality at a single suture strongly influences the development of other areas in the craniofacial complex.

Age Factors↗
PubMed1980

Susceptibility of brain and skin to bacterial challenge.

The brain is a uniquely protected organ. Once the protective barriers are overcome, the brain is susceptible to bacterial infection. Using a reproducible rat model, the susceptibility of brain tissue to challenge by S. aureus or E. coli was quantitatively compared to that of skin. Brain was significantly more susceptible to the presence of bacteria than was the skin of the scalp. The development of infection in skin required at least 10(5) organisms, while brain infection could be produced with as few as 100 organisms.

Animals↗
PubMed1979

Production of experimental brain abscess in the rat.

Experimental evaluation of brain abscess has been inhibited by the lack of a simple and reproducible model in small animals. A stereotaxic headholder and slow infusion of 1 microliter of saline, containing a known number of bacteria, were used to produce brain abscess consistently in the rat. The natural history of the brain abscess produced by this technique closely simulated that found in the human clinical situation.

Animals↗
PubMed1979

Side-effects of topical proteolytic enzyme treatment.

The results of this study indicate that short term treatment of wounds with topical enzymes appears to be safe and is accompanied by no clinically significant side-effects. Topical wound treatment with this enzyme did not interfere either with healing of experimental wounds or the activity of the antibiotics. Wounds subjected to this enzyme treatment exhibited a normal capacity to resist infection, even though this enzyme interferred with leukocyte phagocytosis in vitro. The potential benefits of this treatment in experimental wounds as an adjunct to antibiotics considerably outweigh its damaging effects. Its clinical use in patients must await the results of carefully controlled clinical trials in which the efficacy of this treatment is evaluated.

Administration, Topical↗
PubMed1978

Debridement: an essential component of traumatic wound care.

The harmful influences of devitalized tissue on wound defenses are documented and the importance of wound debridement in the care of the traumatic wound is stressed. All devitalized soft tissues damaged the host's defenses and encouraged the development of infection. The capacity of divitalized muscle, fat, and skin to enhance infection was comparable. The infection-potentiating effect of skin was enhanced by exposing it to a dry thermal injury. The mechanisms by which devitalized soft tissue enhanced infection are several. The devitalized soft tissue acts as a culture medium promoting bacterial growth. In addition, the devitalized tissue inhibits leukocyte phagocytosis of bacteria and subsequent kill. Finally, the anaerobic environment within the devitalized tissue may also limit leukocyte function.

Debridement↗
PubMed1977

Nonoperative management of fingertip pulp amputation by occlusive dressings.

Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. Healing of the amputated fingertip occurred within four weeks. The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic appearance. This satisfactory outcome was realized with less than ten days lost from work.

Aluminum↗