WCET Journal - Spanish Edition

Objective To review how different classes of immunosuppressants affect wound healing.

Data Sources A literature search was conducted in PubMed, Google Scholar, and the University of Calgary Health Sciences Library.

Study Selection The researchers initially screened article titles using key words such as “immunosuppressive medication,” “wound healing,” and “immunosuppression.” Articles in which the title and/or abstract contained these key words, that addressed wound healing related to immunosuppressant medications, and were published after 2000 were included in the review. When human data were not available for an immunosuppressant (class), animal studies were included.

Data Extraction The 61 included articles underwent full text review and summarisation.

Data Synthesis: All included studies were summarised descriptively including immunosuppressive mechanism of action, study participants or subjects, and evidence of effects on wound healing.

Conclusions Corticosteroids and mechanistic target of rapamycin inhibitors most consistently demonstrate detrimental effects on wound healing. For other classes of immunosuppressants, evidence is limited with varying effects on wound healing described. Larger, high-quality studies are required to better understand the effects of immunosuppressants, including those with new mechanisms of action, to identify those with the most impact on wound healing.

Haematomas of the lower limb are traumatic wounds that can have serious and often debilitating consequences; especially in the aged. Wound healing may be protracted due to multiple factors including disruptive consumer behaviours from poor cognition from dementia.

This case study describes the management of an elderly consumer with dementia in a nursing home who sustained an extensive haematoma that resulted in a complex wound. Wound management was provided under local restrictions imposed by COVID-19.

The importance of using holistic wound assessment frameworks and evidence-based approaches to wound management to achieve positive wound healing outcomes are emphasised.

Convexity products for ostomy care have been available many years. However, there still remains confusion regarding both nomenclature regarding convexity products and their clinical application. This gap creates a non-scientific approach to patient care as the clinician often relies on personal experiences creating more of an ‘art-based’ approach rather than care delivered from evidence.

Recent publications are helping to improve the base knowledge of the clinician with new evidence that supports such clinical decision making in clinical practice. Ultimately, this evidence-based approach can improve patient outcomes by facilitating quality care while assisting product developers to create products that are more humanistic and patient-centered.

This article explores some of this recent evidence, some clinical applications substantiated by evidence, and the potential for future product developments and ostomy product standardisation.

Evidence supporting clinical decision-making in the specialty of ostomy care regarding prescriptive product use has been sparse. Many clinical decisions in ostomy care have been based on either clinician experience, or from teachings and beliefs that have evolved over many years but are not based in evidence. There is now a rich and varied tapestry of evidence supporting clinicians regarding the use of convexity earlier in the patient’s journey, particularly of the more compressible types (soft) convexity products.

This article reviews the recent evidence concerning the use of more compressible barriers in ostomy care, a relatively newer addition to the clinician’s armamentarium, for managing patients. It provides an analysis of the data that supports using these products, sooner rather than later, in achieving a more secure skin seal, and improving patient outcomes compared with using flat skin barriers.

Driving changes to clinical practice can be a daunting task. However, if meaningful change is to occur, the use of evidence to support the decision for change can be crucial in gaining agreement with stakeholders. This article describes the journey taken at one institution by a clinician following the trail of evidence that has recently been developed regarding the use of convexity with a barrier ring, earlier in the patient journey for creating positive impacts in  patient outcomes.