A case-study of the experiences of junior medical officers in the emergency departments of a metropolitan hospital and rural hospital.

Objective: Increased exposure to post-graduate rural medical training is associated with increased likelihood of future rural practice. Training rotations in rural emergency departments provide a possible avenue for such exposure, but have been under-investigated. This study aimed to compare junior medical officers' emergency department experiences in a metropolitan and a rural hospital to inform rural health workforce initiatives.

A Predictive Model for Diabetic Foot Ulcer Outcome: The Wound Healing Index.

To develop a healing index for patients with diabetic foot ulcers (DFUs) for use in clinical practice, research analysis, and clinical trials. U.S.

A predictive model for pressure ulcer outcome: the Wound Healing Index.

Purpose: The purpose of this learning activity is to provide information regarding the creation of a risk-stratification system to predict the likelihood of the healing of body and heel pressure ulcers (PrUs).

Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

Objectives: After participating in this educational activity, the participant should be better able to:1.

When a LIC came to town: the impact of longitudinal integrated clerkships on a rural community of healthcare practice.

Introduction: Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service.

Diabetic foot ulcer off-loading: The gap between evidence and practice. Data from the US Wound Registry.

Objective: To evaluate the practice of off-loading diabetic foot ulcers (DFUs) using real-world data from a large wound registry to better identify and understand the gap between evidence and practice.

Design: Retrospective, deidentified data were extracted from the US Wound Registry based on patient/wound characteristics, procedures performed, and at which clinic the DFU was treated.

Setting: 96 clinics (23 from the United States and Puerto Rico)

Patients: : 11,784 patients; 25,114 DFUs

Main Outcome Measures: : Healed/not healed, amputated, percent off-loading, percent use of total contact casting (TCC), infection rate

Main Results: : Off-loading was documented in only 2.

Electronic Health Records, Registries, and Quality Measures: What? Why? How?

The transition from volume-based healthcare to value-based care is advancing via the reporting of quality measures, initially as a part of "pay for performance" within Medicare's Physician Quality Reporting System (PQRS) initiative. However, "value-based purchasing" requirements within the Affordable Care Act will increase the percentage of reimbursement linked to the reporting of quality measures. Currently, only five PQRS measures are relevant to wound care, and the venous ulcer care measure will be retired this year.

Development of a wound healing index for patients with chronic wounds.

Randomized controlled trials in wound care generalize poorly because they exclude patients with significant comorbid conditions. Research using real-world wound care patients is hindered by lack of validated methods to stratify patients according to severity of underlying illnesses. We developed a comprehensive stratification system for patients with wounds that predicts healing likelihood.

Examining the relationship between physician and facility level-of-service coding in outpatient wound centers: results of a multicenter study .

The evaluation and management (E/M) services for the physician and the hospital-based outpatient center ("facility") are calculated using different federal regulations. In addition, patients visiting outpatient wound care centers require different levels of care from the physician than the facility. The purpose of this study was to analyze and compare physician and facility E/M level-of-service coding using the electronic wound registry records from three geographically diverse, hospital-based outpatient wound centers.

Estimating the applicability of wound care randomized controlled trials to general wound-care populations by estimating the percentage of individuals excluded from a typical wound-care population in such trials.

Objective: To determine the percentage of individuals that would be excluded from wound care randomized controlled trials (RCTs) as a surrogate for applicability to general populations.

Design: A representative sample of wound-care RCTs was selected from the literature in the past 10 years. Exclusion criteria from the trials were evaluated, and prevalence values for each excluded condition were obtained from a large wound-care population, as well as from the literature.

A retrospective data analysis of antimicrobial dressing usage in 3,084 patients.

Knowledge about practice patterns and optimal usage criteria for topical antimicrobial dressings is limited. A retrospective data analysis was conducted to evaluate: 1) the length of time these dressings are applied in a typical episode of wound care, 2) the number of episodes of antimicrobial dressing use, and 3) whether antimicrobial dressings are applied in consideration of signs and symptoms of infection. Wound care registry data from a level-4 electronic medical record were analyzed, providing information on 3,084 patients older than 17 years seen from July 2003 through December 2008 in 26 hospital-based, outpatient wound centers in 14 states.

The safety of negative pressure wound therapy using vacuum-assisted closure in diabetic foot ulcers treated in the outpatient setting.

The purpose of this project was to evaluate the safety of negative pressure wound therapy using the vacuum-assisted closure (V.A.C.

Limitations of Daily Living Activities in Patients With Venous Stasis Ulcers Undergoing Compression Bandaging: Problems With the Concept of Self-bandaging.

Venous stasis ulcers (VSUs) represent both an enormous cost to the healthcare system and significant quality-of-life issue to patients. While certain high-technology products have shown promise, compression bandaging continues to be the gold standard of care. Recently, some regional Medicare carriers suggested that patients with VSUs should be able to perform self-bandaging in an effort to avoid reimbursing caregivers to provide this service.