Terminal Ulcer Terminology Reconsidered

My new article in Wound Management &Prevention is a critical re-examination of terminal ulcer terminology.  In it I make the case for recognizing terminal ulcers as part of the spectrum of skin failure (and not necessarily heralding death) and used only in situations where patients are recognized as actively dying.  The article presents several reasons why terminal ulcer terminology should be used only in limited fashion.  These include the conflation of diagnosis and prognosis which are separate concepts, inaccuracy of prediction of death, advances in healthcare technology, variation in end-of-life trajectories, and introduction of defensive verbiage that relies on the impending death to relieve caregivers of responsibility for potential quality deficit.  Finally I argue that terminal ulceration needs to be recognized as part of the spectrum of skin failure, drawing on physiology to explain both acute breakdown and impaired wound healing in many patients.    Access my article in Wound Management &Prevention (formerly Ostomy Wound Management) HERE.   * * * * * * * * * * * * * * Related links: Pressure Injuries and the Human Warranty Wound Care in the Geriatrics Review Syllabus Wound Care: What the Medical Director Needs to Know Determining the Avoidability of Pressure Ulcers The post Terminal Ulcer Terminology Reconsidered appeared first on Jeffrey M Levine, MD.
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - Category: Geriatrics Authors: Tags: An Aging World Featured Medical Articles Geriatric Medicine Pressure Injuries & Wound Care Publications Risk Management bedsores decubiti decubitus ulcer end-of-life care geriatrics Healthcare Quality Jeff Levine MD Jeffrey M Lev Source Type: blogs

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CMS has implemented a new quality measure for hospitals that expands the array of pressure injuries considered as adversely impacting quality care.  The new measure, developed in a program to provide electronic clinical quality measures (eCQMs), widens the scope of pressure injury stages that directly infer quality deficit.  The new measure however, bears no consideration for unavoidability of some pressure injuries even when recommended clinical practice guidelines for prevention have been followed.  According to CMS, the benefit of eCQMs is to assess the outcomes of treatment, reduce the burden of manual a...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - Category: Geriatrics Authors: Tags: Featured Medical Articles Geriatric Medicine Pressure Injuries & Wound Care Risk Management bedsores decubiti decubitus ulcer end-of-life care geriatrics Healthcare Quality hospital quality Improving Medical Care Jeff Levine MD J Source Type: blogs
Owing to age-related changes, such as loss of fat and muscle mass, bone protrusion, perceptual loss, and impaired immune function and wound-healing ability, elderly people are prone to develop pressure ulcers (PUs), also known as decubitus ulcers. In aging society, the prevention, treatment, and management of PUs has become important more than ever. In the early stage of PUs formation, non-blanchable erythema and/or purpuric lesions appear in the skin subjected to external pressure, and skin ulcers subsequently develop after 2-3 weeks [1].
Source: Journal of Dermatological Science - Category: Dermatology Authors: Source Type: research
Bed sores, pressure sores, or pressure ulcers are all words used to describe a condition that people often think of as a small problem for a caregiver to handle if they think of it at all. However, this condition is anything but small. Complications from pressure sores can cause death.  Read about bedsores on HealthCentral and how they can be prevented and/or treated: Carol Bradley Bursack is the Candid Caregiver MedicareFAQ – Medicare Resource Center Support a caregiver or jump-start discussion in support groups with real stories - for bulk orders of Minding Our Elders e-mail Carol     ...
Source: Minding Our Elders - Category: Geriatrics Authors: Source Type: blogs
We examined which studies of available support surfaces, new and currently utilized wound dressings or any other treatment modalities have provided ev idence of any greater effectiveness than standard of care in the prevention of pressure injury and in promotion of pressure ulcer healing. Our objective is to provide healthcare providers with an assessment of the relative efficacy of the various interventions available to facilitate their decision- making in the healing of their patient’s pressure ulcers. Goals for pressure injury prevention or treatment, especially in the geriatric population, address repositioning f...
Source: Current Physical Medicine and Rehabilitation Reports - Category: Rehabilitation Source Type: research
I just returned from the American Geriatrics Society Annual Meeting in Portland, Oregon, where parts of my wound care research were presented as a poster. My co-author was geriatrician-in-training Dr. Rikitha Menezes, who participated in data collection. Rikitha came from Canada to New York City for a year of fellowship at the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai where I hold an appointment as Associate Clinical Professor. The third collaborating author was Dr. Santhini Namagiri, an attending physician at the New Jewish Home in Manhattan who holds an appointme...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - Category: Geriatrics Authors: Tags: Featured Medical Articles Geriatric Medicine Long-Term Care Pressure Injuries & Wound Care bedsore bedsores decubiti decubitus ulcer end-of-life care geriatrics gerontology Healthcare Quality Improving Medical Care Jeff Levine MD Source Type: blogs
Many times I’ve been asked to provide a lecture on wound care with an allotted time of 45 minutes to one hour.  The reality is that wound care is so complex that one hour will provide only a superficial overview which may not serve many front-line clinicians.  This year I had the opportunity to organize a half-day program at the Annual Meeting of AMDA/PALTC in Atlanta, recruiting some of the best wound educators in the country.  The title of our program was Wound Care Boot Camp: The Basics and Beyond. The transformation of the nursing home into a post-acute environment has increased acuity levels, caus...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - Category: Geriatrics Authors: Tags: Featured Medical Articles Geriatric Medicine Long-Term Care Pocket Guide to Pressure Ulcers Pressure Injuries & Wound Care bedsores decubiti decubitus ulcer geriatrics Improving Medical Care Jeffrey M Levine MD Nursing Homes pressu Source Type: blogs
  How do you know if your wound is chronic? The severity of your injury, as well as complications that cause significant delays in healing, are common indicators. There are also certain kinds of wounds that often end up high on the chronic scale. Here are the three most common types of chronic wounds: Infectious wounds, surgical sites and ulcers are among the most common chronic wounds. 1. Infectious wounds When infection causes significant delays in healing, the wound often becomes chronic. According to Wound Care Centers, typical signs of chronic infectious wounds include bad odors, pus drainage, dead ti...
Source: Advanced Tissue - Category: Dermatology Authors: Tags: Wound Care Wound Infection chronic wounds Source Type: news
Authors: Skavinski KA Abstract Pain from pressure ulcers can severely impact a patient's quality of life. Evidence-based treatment of ulcer-related pain typically relies on systemic opioids with limiting side effects. Literature exists on the use of topical ketamine for neuropathic pain, but not for tissue injury in general and for decubitus ulcer pain specifically. Ketamine has a number of actions including blocking of the glutamate NMDA ionophore in the periphery. Preclinical evidence suggests that NMDA receptors located on peripheral sensory afferent terminals may play a role in initiating pain signaling in infl...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
Bruin Biometrics (BBI) is looking to shake up the way patients are assessed for pressure ulcers with its SEM scanner. FDA granted de novo marketing authorization for the device which can help uncover a patient’s risk for bedsores and gauge whether there is tissue damage. The current standard for assessing pressure ulcers requires clinicians or healthcare givers to visually inspect patients' skin and remember to turn them over in their beds every few hours. The current standard also relies on risk assessment scales that judge which patients are most at risk for developing pressure ulcers and monitor them. ...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Sterilization Source Type: news
  Bruin Biometrics’ SEM Scanner Bruin Biometrics said it has landed FDA de novo clearance for its SEM Scanner, a wireless, handheld device to help assess patients at increased risk for pressure ulcers. The scanner is a novel device that can objectively alert clinicians to specific anatomical areas of a patient’s body at increased risk for developing pressure damage before that damage is visible at the skin surface. Pressure sores typically appear at areas of bony prominence, such as the heels and sacrum. Get the full story on our sister site, Medical Design &Outsourcing. The post Bruin Biometrics&...
Source: Mass Device - Category: Medical Devices Authors: Tags: Blog Source Type: news
More News: Decubitus Ulcer (bed sore) | Geriatrics | Physiology | Pressure Sores | Skin | Wound Management