Volume 47 - Issue 11 - November, 2001
Before and After
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Index: Ostomy Wound Manage 2001;47(11):6
Our October issue went to press just before September 11. How the world has changed. Before September 11, most conversations and correspondence began with "How are you?" followed by the standard reply, "Fine, how about yourself?" After September 11, most conversations began by asking your conversational partner if he or she was personally affected by the tragic events of that day.
Before September 11, the terms survivors guilt and post traumatic stress syndrome were the stuff of professional healthcare jargon. Now, they are part of our everyday vocabulary because countless numbers of people are experiencing these conditions. Some people were directly affected by the attacks: the families and friends of the deceased and missing, the search and rescue workers, the people who were supposed to be in the targeted buildings or hijacked airplanes but had a change in plans. Most of us managed to escape the immediate terror, but not the residual emotions. Thousands of healthcare professionals stood ready to assist but didn't have victims to help. Others continue to care for the victims with resources that already were spread too thin.
A Poor Prognosis for “The Nursing Disease”
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Index: Ostomy Wound Manage 2001;47(11):8–9
There are no such things as incurables; there are only things for which man has not found a cure.
- Bernard M. Baruch
Years ago, thousands of us entered the field of nursing - wide-eyed and eager - with the heartfelt desire to nurture the sick and dying. Few other career alternatives for women were as prestigious and paid as well. Years later, we find our numbers dwindling; many are burned out, used up, and dread getting up and going to work. In 2000, more than half of us complained that we were dissatisfied with our jobs.1 The number of individuals passing the national RN licensing exam is down 23% from 1996.2 In fact, 55% of us would not recommend nursing as a career; 23% of us would actively discourage someone from entering the profession.3 Why? What?s happened?
Age
Today, the 2.6 million American nurses (of which, 95% are women) are the largest group of healthcare providers in the country, representing 40% of acute care costs and about 70% of home care costs. Last year, statistics revealed that fewer than one in three nurses were younger than 40 years old (9% of nurses were under 30 and 35% were between 40 and 49). The number of employed RNs has declined in recent years, as has their national unemployment rate (1% in 2000)2 - the lowest in more than a decade. As opportunities for women outside of nursing have expanded and earning power has increased, the shriveling numbers of young women entering nursing have created a narrowing pipeline for the care of the rapidly aging baby boomer population. By 2010, about 40% of nurses will be more than 50 years old. By 2020, a 20% shortfall of full time equivalent RNs will be required to meet demand.2
The Modernity of Ostomy
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Index: Ostomy Wound Manage 2001;47(11)
There is nothing past for which one may yearn, there is only an eternal newness which is shaped by the wider elements of the past and true nostalgia has always to be productive to create a new excellence. — Johann Wolfgang von Goethe
A few weeks ago, my husband and I were driving back to Canada after visiting our family in the US. As usual, we tuned into talk radio. After listening to a lecture on "modernity" – a completely new term for me – I began to ponder how the term could be applied to ostomy supplies and the way individuals with an ostomy live in the 21st century.
Hooker1 defines modernity as the sense or idea that the present is discontinuous with the past. Due to a process of social and cultural change (either through improvement or decline) life in the present is fundamentally different from life in the past.1 This is the opposite of tradition, which is simply the sense that the present is continuous with the past, repeating its forms, behavior, and events.
Worth Reading
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Index: Ostomy Wound Manage 2001;47(11):10
Normally, Ostomy/Wound Management reviews books. Occasionally, however, other publications in the field merit the attention of our readers. The monograph and clinical practice guideline reviewed below are excellent sources of clinical and practical information on the types of wounds that increasingly are gaining the attention and stretching the resources of medical professionals.
"We Are Under Attack"
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Index: Ostomy Wound Manage 2001;47(11):13–16
In the September 2001 issue of Ostomy/Wound Management, Alan J. Cantor, DPM, CWS, FACFAOM, Diplomat of the American Board of Podiatric Orthopedics, was recognized for his passion for learning and teaching, as well as for establishing a humanitarian project in the Caribbean. He never imagined that he would be asked to share his thoughts again so soon, especially on such devastating events. A decorated volunteer fireman accustomed to responding to many accidents and catastrophic emergencies in his 23 years of service, Dr. Cantor was awarded the Medal of Valor for his role as triage commander at the crash site of Avianca Flight 52 in January 1990 in Cove Neck, NY. The following is Dr. Cantor's account of the attacks on September 11, 2001.
Applying Split-Thickness Skin Grafts: A Step-by-Step Clinical Guide and Nursing Implications
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Index: Ostomy Wound Manage 2001;47(11):20–26
Healing by second intention is the most predictable method in the terminal phase of wound healing. It is also the most damaging, frustrating, time consuming, (and) economically devastating.1
Split-thickness skin graft application is typically indicated for temporary or permanent coverage of cutaneous defects.2 These grafts traditionally are used to cover large areas of skin loss, granulating tissue beds, tissue loss across joints in areas where contraction will cause deformity, and where epithelialization alone will produce an unstable wound cover.3 Split-thickness autografts include epidermis and part of the dermis, depending on graft thickness. Some dermal skin appendages (eg, sweat glands, hair follicles, and sebaceous glands) remain at the donor site, which heals by epithelialization.4
Prevalence and Incidence Studies of Pressure Ulcers in Two Long-Term Care Facilities in Canada
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Index: Ostomy Wound Manage 2001;47(11):28–34
Prevalence is a cross-sectional count of the number of cases of a medical condition at a specific point in time. Incidence is the number of new cases occurring over a given time period. A prevalence and incidence study is a combination of two studies that, when done consecutively, provides a facility with key statistics on patients with an existing medical condition and on those who acquire that condition during their stay.
Wide variation exists in the prevalence and incidence rates of pressure ulcers reported in the medical and nursing literature. The reasons for the variation in the rates are multiple; they include differences in the population of patients studied, differences in data collection and study methodology, and differences in the quality of care provided. Data collected from patients in tertiary care hospitals may not be comparable with data from residents in long-term care facilities (LTCFs).
A Historical Overview of Pressure Ulcer Literature of the Past 35 Years
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CAWC Abstracts
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Index: Ostomy Wound Manage 2001;47(11):44–51
The 7th Annual Conference of the Canadian Association of Wound Care met in London, Ontario, November 1 through 3. The focus of the conference was "The Many Faces of Wound Caring: Interdisciplinary Teams Providing Patient-Centered Care." Ostomy/Wound Management is fortunate to have received a number of rigorously reviewed abstracts presented at CAWC that illustrate the breadth and depth of research relevant to wound care. These abstracts were selected for publication by an interdisciplinary abstract review committee comprising a total of seven of the authors' peers. An equal number of abstracts were selected from oral and poster presentations. In publishing these abstracts, the editors hope to increase attention to the issues they address, expedite necessary changes to care protocols, and stimulate further research efforts among clinicians who may take the value of their day-to-day accumulation of knowledge for granted.
November 2001 Industry News
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Index: Ostomy Wound Manage 2001;47(11):53
Aquacel(R) reimbursement announced
Effective immediately, Aquacel® Hydrofiber® (ConvaTec, Princeton, NJ) wound dressing is being reimbursed by Medicare Part B under the Calcium Alginate dressing category. Until now, the product had been reimbursed under the Specialty Absorptive dressing category. This change makes the allowable for the product substantially higher. Please contact your ConvaTec representative at (800) 422-8811 with any questions.
Dermagraft(R) pre-approved for diabetic foot ulcers
Advanced Tissue Sciences, Inc. (La Jolla, Calf.) and Smith and Nephew (Largo, FL) received notification from the United States Food and Drug Administration that the agency has given the Premarket Approval Application for Dermagraft® for the treatment of chronic foot ulcers in patients with diabetes. This decision makes Advanced Tissue Sciences the first company to gain FDA approval for a tissue-engineered, living dermal substitute that is human-based, mass-produced, and cryopreserved. The product's 6-month shelf life allows for important safety testing to be performed before any product is released, distinguishing it from products that are not cryopreserved.
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