Granulox Update on evidence and science
|
|
- Rosamund Berry
- 5 years ago
- Views:
Transcription
1 Update on evidence and science
2 New clinical data in DFU wounds Retrospective cohort evaluation Site: Southtees, UK Main Inclusion criteria: DFU, < wound size reduction in 4 weeks Verum Group: Standard care + Sham Group: Standard care alone Patients enrolled: 40 Duration: 6 months Status: Paper published Diabetic Foot & Ankle Sharon D. Hunt and Fredrik Elg. 2
3 There was no significant difference at baseline between the groups Tests of difference between groups at baseline [t-test, Chi-square] 1 1,00 Critical (p<0.05) p-value 0,90 0,80 0,70 0,60 0,50 0,40 0,30 0,20 0,10 p<0.05 0,00 Age HbA1c Wound size Healing rate Ulcer type History SINBAD Neuropathy Vascular Off-loading 1 Continuous variables compared using t-test, nominal variables compared using Chi-square test 3
4 healed wounds 16 20/20 patients Diabetic foot ulcer Significantly higher rates of wound closure/healed wounds Week of treatment n= Control Sharon Dawn Hunt, Fredrik Elg. Clinical effectiveness of hemoglobin spray ( ) as adjunctive therapy in the treatment of chronic diabetic foot ulcers. Diabetic Foot & Ankle 2016, 7:
5 % wound size change 0 Diabetic foot ulcer Wound size reduction vs. standard care Week of treatment 20/20 patients n= Control Sharon Dawn Hunt, Fredrik Elg. Clinical effectiveness of hemoglobin spray ( ) as adjunctive therapy in the treatment of chronic diabetic foot ulcers. Diabetic Foot & Ankle 2016, 7:
6 % sloughy tissue coverage 60 Diabetic foot ulcer Rapid reduction of wound slough/sloughy tissue coverage Week of treatment 20/20 patients n= Control Sharon Dawn Hunt, Fredrik Elg. Clinical effectiveness of hemoglobin spray ( ) as adjunctive therapy in the treatment of chronic diabetic foot ulcers. Diabetic Foot & Ankle 2016, 7:
7 4,5 4 3,5 3,60 4,1 Diabetic foot ulcers Pain score Week of treatment 20/20 patients n= ,5 2,45 2 1,5 1,44 1,22 1,17 1 0,5 0 0,72 0,72 0,44 0,25 0, Week Control Sharon Dawn Hunt, Fredrik Elg. Clinical effectiveness of hemoglobin spray ( ) as adjunctive therapy in the treatment of chronic diabetic foot ulcers. Diabetic Foot & Ankle 2016, 7:
8 New clinical data in chronic, slow healing wounds Retrospective cohort evaluation Site: Southtees, UK Main Inclusion criteria: < wound size reduction in 4 weeks, wounds of different etiologies Verum Group: Standard care + Sham Group: Standard care alone Patients enrolled: 100 Duration: 6 months Status, Finished, paper submitted The clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of chronic wounds; THE JOURNAL OF WOUND CARE VOL 26, NO 9, SEPTEMBER 2017, Fredrik Elg, Sharon Dawn Hunt 8
9 % sloughy tissue coverage Pain score healed wounds % wound size change Control Control ,5 4 4, ,5 3 2,5 3,2 2,8 2, ,5 1 0,5 0 1,3 0,7 0,8 0,1 0,2 0,2 0,3 0,2 0,3 0,2 0,3 0, Control Control The clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of chronic wounds; THE JOURNAL OF WOUND CARE VOL 26, NO 9, SEPTEMBER 2017, Fredrik Elg, Sharon Dawn Hunt 9
10 New clinical data in slow healing & sloughy wounds Retrospective cohort evaluation Site: Southtees, UK Main Inclusion criteria: < wound size reduction in 4 weeks, > slough coverage Verum Group: Standard care + Sham Group: Standard care alone Patients enrolled : 200 Duration: 6 months Status, Finished, paper accepted CLINICAL EFFECTIVENESS OF HAEMOGLOBIN SPRAY AS ADJUNCT THERAPY IN SLOUGHY WOUNDS PAPER ACCEPTED Fredrik Elg, Sharon Dawn Hunt 10
11 % sloughy tissue coverage Average pain score healed wounds % wound size change Standard Control , ,4 1,9 1 0,6 0,3 0,4 0,1 0,2 0,1 0,2 0,2 0,2 0,2 0,1 0, Standard Standard CLINICAL EFFECTIVENESS OF HAEMOGLOBIN SPRAY AS ADJUNCT THERAPY IN SLOUGHY WOUNDS PAPER ACCEPTED Fredrik Elg, Sharon Dawn Hunt 11
12 Comparison with other oxygenating devices 12
13 Substantial body of evidence Keynumbers for publications TOTAL Number of RCTs, published 2 Non-randomized retrospectively controlled 10 Case series > with 1 or more patients 43 Case series > with 10 or more patients 19 13
14 EpiFix has been demonstrated as the new benchmark Results of EpiFix vs Apligraf trial % 85% 95% 4 weeks 6 weeks Inclusion criteria: DFUs with less than reduction in wound size during 2-week run-in period including Camboot offloading Treatment: Off-loading switched to Camwalker and Apligraf or EpiFix groups, grafts applied every week plus non-adherent layer (Adaptic Touch), a moisture-retentive dressing (NuGel) and a compressive dressing. Standard care group dressed with a collagen-alginate dressing secured with gauze % 35% 3 Apligraf Epifix Standard Care Source: Zelen, C. M., Gould, L., Serena, T. E., Carter, M. J., Keller, J. and Li, W. W. (2015), A prospective, randomised, controlled, multicentre comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers. Int Wound J, 12: doi: /iwj
15 15
16 Overview of systematic review methodology (1) HBOT MTOT HACM Hyperbaric Oxygen Therapy Moist Topical Oxygen therapy Human amniotic/chorion membrane Haemoglobin facilitated diffusion MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. ( Systematic review OR Meta-Analysis ) AND ( HBOT OR Hyperbaric AND ( Ulcer* or Wound* ): 40 Abstracts reviewed ( Systematic review or meta-analysis ) AND Topical AND Oxygen AND ( Ulcer* or Wound* ): 8 Abstracts reviewed ( Systematic review or Meta-analysis ) AND ( dhacm OR Amniotic* AND ( Ulcer* or Wound* ): 6 Abstracts reviewed ( Systematic review or Meta-analysis ) AND ( Topical OR Spray OR Adjunct ) AND ( Haemoglobin OR Hemoglobin ) AND ( Ulcer* or Wound* ): 9 Abstracts reviewed 16
17 Overview of systematic review methodology (2) HBOT MTOT HACM Hyperbaric Oxygen Therapy Moist Topical Oxygen therapy Human amniotic/chorion membrane Haemoglobin facilitated diffusion Exclusions: Not chronic wound healing related (i.e. radiation, infection only etc excluded) 21 systematic reviews identified and evaluated for comparative evidence in human chronic ulcers 6 Additional systematic reviews identified during review Exclusions: Not chronic wound healing related (i.e. radiation, acute wounds only etc excluded) 8 systematic reviews selected and evaluated for comparative evidence in human chronic ulcers 7 Additional systematic reviews identified during review Exclusions: Not chronic wound healing related (i.e. radiation, acute wounds only etc excluded) 3 systematic reviews selected evaluated for comparative evidence in human chronic ulcers 5 Additional systematic reviews identified during review Exclusions: Not chronic wound healing related 0 systematic reviews with relevant data identified from MEDLINE search 13 Additional potential reviews identified during review 17
18 Overview of systematic review methodology (3) HBOT MTOT HACM Hyperbaric Oxygen Therapy Moist Topical Oxygen therapy Human amniotic/chorion membrane Haemoglobin facilitated diffusion Additional search for new comparative evaluations published in 2017 and 2018 that may have been missed in systematic reviews: ( HBOT OR Hyperbaric ) AND ( Randomi* OR Control* ) AND ( Wound* OR Ulcer* ) 0 Additional evaluations identified via de-novo search 27 unique original comparative studies identified and evaluated 8 meeting quality and comparability criteria (results extracted). Additional search for new comparative evaluations published in that may have been missed in systematic reviews: ( Topical OR Transcutaneous ) AND Oxygen AND ( Randomi* or Control* ) 4 Additional potential evaluations identified via de-novo search 26 unique original comparative studies identified and evaluated 8 meeting quality and comparability criteria (results extracted). Additional search for new comparative evaluations published in that may have been missed in systematic reviews: ( dhacm OR Amniotic* ) AND ( Ulcer* or Wound* ) AND ( Randomi*ed or Control* ) 5 Additional potential evaluations identified via de-novo search 21 unique original comparative studies identified and evaluated 10 meeting quality and comparability criteria (results extracted). Additional search for evaluations missed in systematic reviews: ( Randomi* or Control* ) AND ( Topical OR Spray OR Adjunct ) AND ( Haemoglobin OR Hemoglobin ) AND ( Ulcer* or Wound* ) 6 addition via de-novo search, and reference checks 25 unique original comparative studies identified and evaluated 7 meeting quality and comparability criteria (results extracted). 18
19 Overview of systematic review methodology HBOT MTOT HACM Hyperbaric Oxygen Therapy Moist Topical Oxygen therapy Human amniotic/chorion membrane Haemoglobin facilitated diffusion MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. MEDLINE search for systematic reviews vs standard or care for chronic ulcers, plus additional expanded search for more recent controlled evaluations not yet included in a systematic review. ( Systematic review OR Meta-Analysis ) AND ( HBOT OR Hyperbaric AND ( Ulcer* or Wound* ): 40 Abstracts reviewed Exclusions: Not chronic wound healing related (i.e. radiation, infection only etc excluded) ( Systematic review or meta-analysis ) AND Topical AND Oxygen AND ( Ulcer* or Wound* ): 8 Abstracts reviewed Exclusions: Not chronic wound healing related (i.e. radiation, acute wounds only etc excluded) ( Systematic review or Meta-analysis ) AND ( dhacm OR Amniotic* AND ( Ulcer* or Wound* ): 6 Abstracts reviewed Exclusions: Not chronic wound healing related (i.e. radiation, acute wounds only etc excluded) ( Systematic review or Meta-analysis ) AND ( Topical OR Spray OR Adjunct ) AND ( Haemoglobin OR Hemoglobin ) AND ( Ulcer* or Wound* ): 9 Abstracts reviewed Exclusions: Not chronic wound healing related 21 systematic reviews identified and evaluated for comparative evidence in human chronic ulcers 8 systematic reviews selected and evaluated for comparative evidence in human chronic ulcers 3 systematic reviews selected evaluated for comparative evidence in human chronic ulcers 0 systematic reviews with relevant data identified from MEDLINE search 6 Additional systematic reviews identified during review 7 Additional systematic reviews identified during review 5 Additional systematic reviews identified during review 13 Additional potential reviews identified during review Additional search for new comparative evaluations published in 2017 and 2018 that may have been missed in systematic reviews: ( HBOT OR Hyperbaric ) AND ( Randomi* OR Control* ) AND ( Wound* OR Ulcer* ) Additional search for new comparative evaluations published in that may have been missed in systematic reviews: ( Topical OR Trans-cutaneous ) AND Oxygen AND ( Randomi* or Control* ) Additional search for new comparative evaluations published in that may have been missed in systematic reviews: ( dhacm OR Amniotic* ) AND ( Ulcer* or Wound* ) AND ( Randomi*ed or Control* ) Additional search for evaluations missed in systematic reviews: ( Randomi* or Control* ) AND ( Topical OR Spray OR Adjunct ) AND ( Haemoglobin OR Hemoglobin ) AND ( Ulcer* or Wound* ) 0 Additional evaluations identified via de-novo search 4 Additional potential evaluations identified via de-novo search 5 Additional potential evaluations identified via de-novo search 6 addition via de-novo search, and reference checks 27 unique original comparative studies identified and evaluated 26 unique original comparative studies identified and evaluated 21 unique original comparative studies identified and evaluated 25 unique original comparative studies identified and evaluated 8 meeting quality and comparability criteria (results extracted). 8 meeting quality and comparability criteria (results extracted). 10 meeting quality and comparability criteria (results extracted). 7 meeting quality and comparability criteria (results extracted). 19
20 healing benefits in DFUs are the highest Comparison of mean published healing rates by week vs standard of care in patients with diabetes and lower leg and foot ulcers, across four advanced wound care technologies - excluding studies in amputation candidates with gangrene and data with treatment refusers as controls HBOT MTOT HACM Hyperbaric Oxygen Therapy including only standard care controlled data* Gaseous Moist Topical Oxygen therapy (including intermittent delivery)* Human amniotic/chorion membrane including frozen and dehydrated* Continuous haemoglobin facilitated oxygen diffusion * Unhealed patients by week* Unhealed patients by week* Unhealed patients by week* Unhealed patients by week* RR (relative chances of healing by 24 weeks) RR (increased chance of healed at 24 weeks RR (increased chance of healed at 24 weeks RR (increased chance of healed at 24 weeks HBOT 1, HBOT increases chances of healing by 68% * Pooled unweighted data from Duzgun 2008, Fedorko 2016, Kessler 2003, Löndahl 2010, Ma 2013, Margolis n=181 vs n=181 (plus Margolis) TOT 1, TOT increases chances of healing by 8% * Pooled unweighted data from Blackman 2010, Driver 2013, Driver 2017, Lavery 2017, Niederauer 2017, Ogenix 2014, Yu 2016 Amniotic membranes 1, HACM increases chances of healing by 76% * Pooled unweighted data from DiDomenico 2016, Lavery 2014, Mohajeri 2016, Snyder 2016, Zelen 2013, Zelen 2016 (n=153 vs n=154) ** The Granlox data not specifically identified as DFUs but rather lower leg ulcers, however investigator review noted that these patients were all diabetic, hence included in DFU selection ,70 increases chances of healing by 27 * Data from Arenberger 2011 (lower leg ulcers)**, Hunt 2017b (Unique DFU subset from three independent evaluations) (n=37 vs n=51) 20
21 Also, when including only regular standard care Comparison of published healing rates vs standard of care in DFUs, across four advanced wound care technologies, excluding studies with a non-standard, standard care arm, i.e. excluding control arms using gauze and/or petroleum jelly as standard care dressing regimen. HBOT MTOT HACM Hyperbaric Oxygen Therapy including only standard care controlled data* Gaseous Moist Topical Oxygen therapy (including intermittent delivery)* Human amniotic/chorion membrane including frozen and dehydrated* Continuous haemoglobin facilitated oxygen diffusion * Unhealed patients by week* Unhealed patients by week* Unhealed patients by week* Unhealed patients by week* RR (relative chances of healing by 24 weeks) RR (relative chance of healing by 24 weeks) RR (relative chance of healing by 24 weeks) RR (relative chance of healing by 24 weeks) HBOT 1,68 TOT 1,18 Amniot 1,60 2, HBOT increases chances of healing by 68% * Pooled unweighted data from Duzgun 2008, Fedorko 2016, Kessler 2003, Löndahl 2010, Ma 2013, Margolis 2013, TOT increases chances of healing by 18% * Pooled unweighted data from Blackman 2010, Driver 2013, Driver 2017, Lavery 2017, Niederauer 2017, Ogenix 2014, Yu 2016 (n=126 vs n=124) HACM increases chances of healing by * Pooled unweighted data from DiDomenico 2016, Lavery 2014, Snyder 2016, Zelen 2013, Zelen 2016 (n=126 vs n=124) increases chances of healing by 198% * Pooled unweighted data from Hunt 2017b (Unique DFU subset from three independent evaluations)** (n=23 vs n=37) ** The Arenberger 2011 data no longer included as the dressing regimen in the control arm used Vaseline cover as primary dressing and cotton pads as secondary dressing. 21
22 Healing in VLUs are also among highest observed Comparison of published healing rates vs standard of care in VLUs, across four advanced wound care technologies HBOT MTOT** HACM Hyperbaric Oxygen Therapy including only standard care controlled data* Gaseous Moist Topical Oxygen therapy (including intermittent delivery)* Human amniotic/chorion membrane including frozen and dehydrated* Continuous haemoglobin facilitated oxygen diffusion * Wound size vs baseline by week* Wound size vs baseline by week* Wound size vs baseline by week* Wound size vs baseline by week* Speed (%/week) 6.86x Speed (%/week) 1.58x Speed (%/week) 1.55x Speed (%/week) 5.33x HBOT increases mean chronic VLU healing speed by >50 TOT increases mean chronic VLU healing speed by 58% HACM increases mean chronic VLU healing speed by 55% increases mean chronic VLU healing speed by >50 * Data from Hammarlund 1994 (note very small sample n=8+8 * Pooled unweighted data from Sultan 2016, Tawfick 2009 (n=113 vs n=102), **However control groups based on patient choice, not randomised * Pooled unweighted data from Bianchi 2018, Serena 2014 (n=105 vs n=88) * Pooled unweighted data from Arenbergerova 2013 and Hunt 2017b (VLU subset from three independent evaluations) (n=50 vs n=45) 22
23 Studies currently underway UK: RCT on DFU (20/20) Portugal: Italy: Asia: Retrospectively controlled cohort study (DFU) Retrospectively controlled cohort study (VLU) RCT Pilot HBOT+GX / HBOT / SoC Outlook US: Phase III trial on DFU patients 23
24 More than 60 scientific publications provide substantial evidence: Speed Save money >5 faster healing Safety >60,000 Patients treated in >30 countries >5 cost saving potential Quality of life Substantial and immediate pain reduction 24
25 25
Clinical Policy: EpiFix Wound Treatment
Clinical Policy: Reference Number: PA.CP.MP.140 Effective Date: 03/18 Last Review Date: 04/18 Coding Implications Revision Log Description EpiFix (MiMedx Group) is dehydrated human amniotic tissue that
More informationOxygen is required for normal cellular
Article The role of topical oxygen therapy in the management of diabetic foot ulcer s in Scotland: round table recommendations Citation: Stang D, Young M, Wilson D et al (18) The role of topical oxygen
More informationThe Georgetown Team Approach to Diabetic Limb Salvage: 2013
The Georgetown Team Approach to Diabetic Limb Salvage: 2013 John S. Steinberg, DPM FACFAS Associate Professor, Department of Plastic Surgery Georgetown University School of Medicine Disclosures: None Need
More informationAdvanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review
Department of Veterans Affairs Health Services Research & Development Service Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review November 2012 Prepared
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: April 15, 2018 Related Policies: 2.01.16 Recombinant and Autologous Platelet-Derived Growth Factors for Healing and Other Non Orthopedic Conditions 7.01.113 Bioengineered
More informationAccelerate wound healing of acute and chronic wounds in patients with Diabetes: Experience from Mexico using supplementary haemoglobin spray.
Accelerate wound healing of acute and chronic wounds in patients with Diabetes: Experience from Mexico using supplementary haemoglobin spray. Obdulia Lopez Lopez 1, Fredrik Elg 2 Peter Engels 3, 1 Universidad
More informationHyperbaric Oxygen Utilization in Wound Care
Hyperbaric Oxygen Utilization in Wound Care Robert Barnes, MD, CWS Hyperbaric Center Sacred Heart Medical Center Riverbend Springfield, Oregon No relevant disclosures Diabetes and lower extremity wounds
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: July15, 2017 Related Policies: 2.01.16 Recombinant and Autologous Platelet-Derived Growth Factors for Healing and Other Non Orthopedic Conditions 7.01.113 Bioengineered
More informationDespite almost 50 years of clinical use, the
4. Topical oxygen therapies Despite almost 50 years of clinical use, the subject of TOT for non-healing wounds remains controversial. 38 42 TOT can be defined as the administration of oxygen applied topically
More informationA Pilot Study of Oxygen Therapy for Acute Leg Ulcers
A Pilot Study of Oxygen Therapy for Acute Leg Ulcers Background: The concept of increasing the oxygen concentration in healing wounds developed originally with hyperbaric oxygen therapy and from the fact
More informationDiabetic Foot Ulcer Treatment and Prevention
Diabetic Foot Ulcer Treatment and Prevention Alexander Reyzelman DPM, FACFAS Associate Professor California School of Podiatric Medicine at Samuel Merritt University Diabetic Foot Ulcers One of the most
More informationDressings do not heal wounds properly selected dressings enhance the body s ability to heal the wound. Progression Towards Healing
Dressings in Wound Care: They Do Matter John S. Steinberg, DPM FACFAS Associate Professor, Department of Plastic Surgery Georgetown University School of Medicine Dressings do not heal wounds properly selected
More informationLower Extremity Wound Evaluation and Treatment
Lower Extremity Wound Evaluation and Treatment Boni-Jo Silbernagel, DPM Describe effective lower extremity wound evaluation and treatment. Discuss changes in theories of treatment in wound care and implications
More informationCPAG Summary Report for Clinical Panel URN 1779, Hyperbaric Oxygen Therapy for Diabetic Lower Limb Ulceration Refractory to Best Standard Care
MANAGEMENT IN CONFIDENCE CPAG Summary Report for Clinical Panel URN 1779, Hyperbaric Oxygen Therapy for Diabetic Lower Limb Ulceration Refractory to Best Standard Care The Benefits of the Proposition No
More informationORIGINAL ARTICLE. Charles M Zelen 1, Thomas E Serena 2, Lisa Gould 3, Lam Le 4, Marissa J Carter 5, Jennifer Keller 6 & William WLi 7
International Wound Journal ISSN 1742-4801 ORIGINAL ARTICLE Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative
More informationHUMAN AMNIOTIC MEMBRANE GRAFTS TO ENHANCE HEALING. Frank Burrows, MBA, EMT David Mason, MD
HUMAN AMNIOTIC MEMBRANE GRAFTS TO ENHANCE HEALING Frank Burrows, MBA, EMT David Mason, MD Good Wound Care Treat the whole patient, not just the hole in the patient Ensure adequate perfusion to wound site
More informationMANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING DR NORLIZAH PAIDI FAMILY MEDICINE SPECIALIST KLINIK KESIHATAN BANDAR MAS KOTA TINGGI JOHOR
MANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING DR NORLIZAH PAIDI FAMILY MEDICINE SPECIALIST KLINIK KESIHATAN BANDAR MAS KOTA TINGGI JOHOR OUTLINE DEFINITION FACTORS CONTRIBUTING TO WOUND DEVELOPMENT
More informationNHS England. Evidence review: Hyperbaric oxygen therapy for diabetic lower limb ulceration refractory to best standard care
NHS England Evidence review: Hyperbaric oxygen therapy for diabetic lower limb ulceration refractory to best standard care NHS England Evidence review: Hyperbaric oxygen therapy for diabetic lower limb
More informationDiabetic foot ulcers (DFUs) are difficult to. Treatment of diabetic foot ulcers with dehydrated amniotic membrane allograft: a prospective case series
Treatment of diabetic foot ulcers with dehydrated amniotic membrane allograft: a prospective case series Objective: A diabetic foot ulcer (DFU) is one of the many potential complications associated with
More informationFirst Coast Service Options (FCSO) Medicare Policy Primer
First Coast Service Options (FCSO) Medicare Policy Primer Medicare Jurisdiction (JN) Florida, Puerto Rico and U.S. Virgin Islands Application of Skin Substitute Grafts for the treatment of DFU and VLU
More informationWPS Medicare Policy Primer
WPS Medicare Policy Primer Medicare Jurisdiction (J5 & J8) NE, KS, IA, MO, IN, & MI Retired skin substitute LCD 3/2016 Indications Apligraf Non-infected partial and full-thickness skin ulcers due to VSU
More informationUse of Non-Contact Low Frequency Ultrasound in Wound Care
Use of Non-Contact Low Frequency Ultrasound in Wound Care BLAIRE CHANDLER SEPTEMBER 29, 2015 VCU DPT CLASS OF 2016 Objectives Patient case overview Examine clinical evidence Review intervention of interest
More informationHaemoglobin. Granulox: TOPICAL HAEMOGLOBIN
QUICK GUIDE Haemoglobin Granulox: TOPICAL HAEMOGLOBIN OXYGEN AND WOUND HEALING 1 Oxygen is needed at all phases of wound healing Insufficient wound tissue oxygenation is a major risk factor for delayed
More informationHyperbarics in Diabetic Wound Care. Aurel Mihai, MD & Brian Kline, MD
Hyperbarics in Diabetic Wound Care Aurel Mihai, MD & Brian Kline, MD Presentation Outline The Scope of the Problem Important Definitions Standard Wound Care Hyperbaric Oxygen as an Adjunct Diabetic Foot
More informationPatient Care Information
Patient Care Information A Guide to Healing Diabetic Foot Ulcers Questions? Contact us: Clinician: Phone #: In case of emergency, dial 9-1-1 Dermal Regeneration Matrix Overview Diabetic foot ulcers are
More informationINTEGRATED THERAPEUTIC SOLUTIONS TO MANAGE AND PREVENT DIABETIC FOOT ULCERS
INTEGRATED THERAPEUTIC SOLUTIONS TO MANAGE AND PREVENT DIABETIC FOOT ULCERS UE REMOVE EXU D R IA ER T C D TISS UIL EB ATE AN DB A REMOVE REBUILD REDUCE Cutimed Siltec Sorbact featuring DACC Technology
More informationUse of an Acellular Regenerative Tissue Matrix Over Chronic Wounds
Use of an Acellular Regenerative Tissue Matrix Over Chronic Wounds D. Heath Stacey, MD Northwest Arkansas Center for Plastic Surgery, Fayetteville, Ark Correspondence: dheathstacey@gmail.com Keywords:
More informationmedically necessary as the evidence is insufficient to determine the effects of the technology on health outcomes.
Medical Coverage Policy Amniotic Membrane and Amniotic Fluid EFFECTIVE DATE: 09 01 2018 POLICY LAST UPDATED: 10 02 2018 OVERVIEW Several commercially available forms of human amniotic membrane (HAM) and
More informationFor wounds to heal, it is essential that
Clinical practice Oxygen therapies for wound healing: EWMA findings and recommendations Author: Finn Gottrup Finn Gottrup is Professor of Surgery, University of Southern Denmark, Copenhagen Wound Healing
More informationEvaluating the use of a topical haemoglobin spray as adjunctive therapy in non-healing chronic wounds a pilot study Liezl Naude
Evaluating the use of a topical haemoglobin spray as adjunctive therapy in non-healing chronic wounds a pilot study Liezl Naude Abstract Wound Management Specialist Eloquent Health & Wellness Centre, Pretoria,
More informationThe management of chronic
Amniotic Membranes for Diabetic Foot Ulcerations Here s an update on their use. By Alison Migonis, DPM and John M. Giurini, DPM The management of chronic diabetic foot wounds poses a significant economic
More informationAssessment of clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of sloughy wounds
Assessment of clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of sloughy wounds Objective: To assess use of an adjunctive topical haemoglobin spray in the treatment of
More informationAdjunctive Therapies: The Use of Skin Substitutes and Growth Factors in Venous Leg Ulceration (VLU)
Adjunctive Therapies: The Use of Skin Substitutes and Growth Factors in Venous Leg Ulceration (VLU) Sami Khan, MD FACS Associate Professor of Surgery Division of Plastic and Reconstructive Surgery SUNY-Stony
More informationOF WOUNDS SENIOR AUDITOR CAROLINAS HEALTHCARE SYSTEM. AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois
1 THE WACKY WORLD OF WOUNDS ERIN RYDELL SENIOR AUDITOR CAROLINAS HEALTHCARE SYSTEM AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois www.ahia.org Carolinas HealthCare System 2 Carolinas
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. MTG Review Decision Document
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Centre for Health Technology Evaluation MTG Review Decision Document Review of MTG5: The MIST Therapy system for the promotion of wound healing This guidance
More informationFORWARD LOOKING STATEMENT
June 2018 FORWARD LOOKING STATEMENT This presentation includes forward looking statements regarding: future incremental insurance coverage; future size of sales force; future approved indications for use
More informationMedical Coverage Policy Amniotic Membrane and Amniotic Fluid EFFECTIVE DATE: POLICY LAST UPDATED:
Medical Coverage Policy Amniotic Membrane and Amniotic Fluid EFFECTIVE DATE: 09 01 2018 POLICY LAST UPDATED: 05 01 2018 OVERVIEW Several commercially available forms of human amniotic membrane (HAM) and
More informationDescription. Section: Medicine Effective Date: April 15, 2015 Subsection: Medicine Original Policy Date: September 13, 2012 Subject:
Last Review Status/Date: March 2015 Description Page: 1 of 6 Low-frequency ultrasound (US) in the kilohertz (KHz) range may improve wound healing. Several noncontact devices have received regulatory approval
More informationCahaba Medicare Policy Primer 1,2 for Apligraf
Cahaba Medicare Policy Primer 1,2 for Apligraf MAC A: AL, GA & TN MAC B: AL, GA, & TN LCD# 31428 Indications Applied to partial- or full-thickness ulcers of the lower extremities (see individual product
More informationDIABETES AND THE AT-RISK LOWER LIMB:
DIABETES AND THE AT-RISK LOWER LIMB: Shawn M. Cazzell Disclosure of Commercial Support: Dr. Shawn Cazzell reports the following financial relationships: Speakers Bureau: Organogenesis Grants/Research Support:
More informationWOUND CARE UPDATE. -Commonly Used Skin Substitute Products For Wound. -Total Contact Casting. Jack W. Hutter DPM, FACFAS, C. ped.
WOUND CARE UPDATE -Commonly Used Skin Substitute Products For Wound Closure -Total Contact Casting Jack W. Hutter DPM, FACFAS, C. ped. Commonly Used Skin Substitute Products for Wound Closure why are they
More informationMark Q. Niederauer, PhD 1, Joel E. Michalek, PhD 2, and David G. Armstrong, DPM, MD, PhD 3. Symposium/Special Issue
695574DSTXXX10.1177/1932296817695574Journal of Diabetes Science and TechnologyNiederauer et al research-article2017 Symposium/Special Issue A Prospective, Randomized, Double-Blind Multicenter Study Comparing
More informationThe concept of self-care is becoming more. Topical oxygen-haemoglobin use on sloughy wounds: positive patient outcomes and the promotion of self-care
Topical oxygen-haemoglobin use on sloughy wounds: positive patient outcomes and the promotion of self-care KEY WORDS Haemoglobin spray Healing, slow healing and non-healing wounds Self-care Slough Topical
More informationPatient Product Information
Patient Product Information REGEN-D 150 (India's First Recombinant Human Epidermal Growth Factor (rhegf) Gel for Diabetic Foot Ulcers) Generic name: [Recombinant Human Epidermal Growth Factor (rhegf)]
More informationTopical haemoglobin spray for diabetic foot ulceration
Topical haemoglobin spray for diabetic foot ulceration Sharon Dawn Bateman This article is reprinted from the British Journal of Nursing, 25 (Tissue Viability Supplement), Vol 24, No 2 Topical haemoglobin
More informationAmputations have long
THE DIABETIC FOOT Prevention of Lower Extremity Amputations Conservative modalities can lessen morbidity. By Priyanka Begur, DPM, MA and Robert G. Frykberg, DPM, MPH Amputations have long been feared as
More informationDisclosures. Outpatient NPWT Options Free up Hospital Beds, but Do They Work? Objectives. Clinically Effective: Does it Work?
4/16/16 Disclosures Consultant, Volcano Corporation Outpatient Options Free up Hospital Beds, but Do They Work? UCSF Vascular Symposium 16 Jonathan Labovitz, DPM Medical Director, Foot & Ankle Center Associate
More informationCharles Zelen, DPM Attila Poka, MD James Andrews, MD
A Prospective, Randomized, Blinded, Comparative Study of Injectable Dehydrated Human Amniotic/Chorionic Membrane (dhacm) in the Treatment of Recalcitrant Plantar Fasciitis Charles Zelen, DPM Attila Poka,
More informationA Post-hoc Analysis of Reduction in Diabetic Foot Ulcer Size at 4 Weeks as a Predictor of Healing by 12 Weeks
A Post-hoc Analysis of Reduction in Diabetic Foot Ulcer Size at 4 Weeks as a Predictor of Healing by 12 Weeks Robert J. Snyder, DPM, CWS; Matthew Cardinal, ME; Damien M. Dauphinée, DPM, FACFAS, CWS; and
More informationCASE 1: TYPE-II DIABETIC FOOT ULCER
CASE 1: TYPE-II DIABETIC FOOT ULCER DIABETIC FOOT ULCER 48 YEAR-OLD MALE Mr. C., was a 48-year old man with a history of Type-II diabetes over the past 6 years. The current foot ulcer with corresponding
More informationMy Diabetic Patient Has No Pulses; What Should I Do?
Emily Malgor, MD Assistant Professor of Surgery University of Oklahoma, Oklahoma City My Diabetic Patient Has No Pulses; What Should I Do? There are no disclosures. Background Diabetes affects 387 million
More informationOriginal Research. and increased bacterial infiltration resulting in a disordered and uncoordinated
Original Research An Evaluation of Healing Metrics Associated With Commonly Used Advanced Wound Care Products For the Treatment of Chronic Diabetic Foot Ulcers Donald E. Fetterolf, MD, MBA, FACP 1 ; Niki
More informationNational Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
More informationPluroGel Burn and Wound Dressing Chicago. 23 May 2014
PluroGel Burn and Wound Dressing Chicago 23 May 2014 A NEW, BREAKTHROUGH SURFACTANT BASED BIOMATERIAL WITH A SPECIAL MOLECULAR STRUCTURE PLUROGEL BIOMATERIAL SPECIAL MOLECULAR STRUCTURE PLUROGEL MICELLE
More informationBIOPAD CASE REPORT STUDIES
BIOPAD TM CASE REPORT STUDIES BIOPADTM CASE SERIES A N A LY S I S A N A LY S I S Wound Healing Rates Wound healing rates were tracked for 28 days in patients with Chronic non-healing wounds using BioPad
More informationAn open letter to the American Diabetes Association board of directors
July 19, 2017 American Diabetes Association Board of Directors c/o Michelle Kirkwood 2451 Crystal Drive, Suite 900 Arlington, VA 22202 UHMS 631 US Highway 1, Suite 307 North Palm Beach, FL Phone: 919-490-5140
More informationo Venous edema o Stasis ulcers o Varicose veins (not including spider veins) o Lipodermatosclerosis
Wound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018 Effective for dates of service on or after July 1, 2018, wound care equipment and supply benefits will change for Texas
More information2016 Chronic Wound Healing Case Series: Statistical Results:
2016 Chronic Wound Healing Case Series: Statistical Results: A Case Series study with an ingestible, calibrated formulation of PLANT-BASED LIPIDs (the adjuvant) at a University Wound Healing & Hyperbaric
More informationClinical Commissioning Policy: Hyperbaric oxygen therapy for diabetic lower limb ulceration (diabetic foot ulcer) (all ages)
Clinical Commissioning Policy: Hyperbaric oxygen therapy for diabetic lower limb ulceration (diabetic foot ulcer) (all ages) NHS England Reference: 1712P 1 NHS England INFORMATION READER BOX Directorate
More informationDiabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist
Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic
More informationHyperbaric Oxygen Therapy for Non-Healing Ulcers in Diabetes Mellitus
Ontario Health Technology Assessment Series 2005; Vol. 5, No. 11 Hyperbaric Oxygen Therapy for Non-Healing Ulcers in Diabetes Mellitus An Evidence-Based Analysis September 2005 Medical Advisory Secretariat
More informationNon-Contact Ultrasound Treatment for Wounds
Non-Contact Ultrasound Treatment for Wounds Policy Number: 2.01.79 Last Review: 1/2018 Origination: 1/2008 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationBest and effective practices of wound care and healing among patients with Diabetes Mellitus
Open Access Clinical Journal of Nursing Care and Practice Research Article ISSN 2639-9911 Best and effective practices of wound care and healing among patients with Diabetes Mellitus Jefferson Garcia Guerrero*
More informationDISCLOSURE STATEMENT 10/8/ BASIC OF ELEMENTS OF LIMB SALVAGE MANAGEMENT
LI MB SALVAGE MANAGEMENT October 11, 2018 DISCLOSURE STATEMENT My opinions do not represent the VA s opinions in regards to product preference No specific proprietary data from the VA has been included
More informationUvA-DARE (Digital Academic Repository) Ischemic and diabetic wounds of the lower extremity Santema, T.B. Link to publication
UvA-DARE (Digital Academic Repository) Ischemic and diabetic wounds of the lower extremity Santema, T.B. Link to publication Citation for published version (APA): Santema, T. B. (2017). Ischemic and diabetic
More informationHIGH- VOLTAGE PULSED CURRENT (HVPC) ELECTRICAL STIMULATION FOR TREATMENT OF DIABETIC FOOT ULCER (DFU) - A REVIEW
Review Article Allied Science International Journal of Pharma and Bio Sciences ISSN 0975-6299 HIGH- VOLTAGE PULSED CURRENT (HVPC) ELECTRICAL STIMULATION FOR TREATMENT OF DIABETIC FOOT ULCER (DFU) - A REVIEW
More informationCGS Medicare Policy Primer
CGS Medicare Policy Primer Medicare Jurisdiction (J15) OH & KY Wound Application of Cellular and/or Tissue Based Products (CTPs) Lower Extremities #L36690 Indications Application of a CTP graft for lower
More informationTopical Oxygen Wound Therapy (MEDICAID)
Topical Oxygen Wound Therapy (MEDICAID) Last Review Date: September 8, 2017 Number: MG.MM.DM.15C8v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or
More informationClinical Policy Title: Topical oxygen therapy
Clinical Policy Title: Topical oxygen therapy Clinical Policy Number: 16.02.05 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 17, 2016 Next Review
More informationHyperbaric oxygen therapy Villanueva E, Johnston R, Clavisi O, Burrows E, Bernath V, Rajendran M, Wasiak J, Fennessy P, Anderson J, Harris A, Yong K
Hyperbaric oxygen therapy Villanueva E, Johnston R, Clavisi O, Burrows E, Bernath V, Rajendran M, Wasiak J, Fennessy P, Anderson J, Harris A, Yong K Authors' objectives To assess the effectiveness of hyperbaric
More informationAuthors' objectives To assess the value of treatments for foot ulcers in patients with Type 2 diabetes mellitus.
A systematic review of foot ulcer in patients with Type 2 diabetes mellitus - II: treatment Mason J, O'Keeffe C, Hutchinson A, McIntosh A, Young R, Booth A Authors' objectives To assess the value of treatments
More informationAppropriate Dressing Selection For Treating Wounds
Appropriate Dressing Selection For Treating Wounds Criteria to Consider for an IDEAL DRESSING Exudate Management Be able to provide for moist wound healing by absorbing exudate or adding moisture Secure
More informationData extraction. Specific interventions included in the review Dressings and topical agents in relation to wound healing.
Systematic reviews of wound care management: (2) dressings and topical agents used in the healing of chronic wounds Bradley M, Cullum N, Nelson E A, Petticrew M, Sheldon T, Torgerson D Authors' objectives
More informationW C ??? Topical oxygen therapy promotes the healing of chronic diabetic foot ulcers: a pilot study. journal of wound care
journal of wound care W C VOLUME 26. NUMBER 11. NOVEMBER 2017??? C Topical oxygen therapy promotes the healing of chronic diabetic foot ulcers: a pilot study *P.D. Hayes, 1 MD FRCS(Ed), Consultant Vascular
More informationIncreased pressures at
Surgical Off-loading of Plantar Hallux Ulcerations These approaches can be used to treat DFUs. By Adam R. Johnson, DPM Increased pressures at the plantar aspect of the hallux leading to chronic hyperkeratosis
More informationCaroline E. Fife, MD. Professor of Geriatrics Baylor College of Medicine Houston, TX. Medical Director CHI St. Luke s Wound Clinic The Woodlands, TX
The Big Squeeze: MIPS and Its Implications to the Wound Care Practitioner Caroline E. Fife, MD Professor of Geriatrics Baylor College of Medicine Houston, TX Medical Director CHI St. Luke s Wound Clinic
More informationStatistics on DM and DFU risk
Disclosure NOTHING Statistics on DM and DFU risk National Institute of Diabetes Digestive & Kidney Diseases: As of September 2011 an estimated 16 million Americans are known to have diabetes, with many
More informationArterial & Venous Ulcers. A Comprehensive Review Assessment & Management
Arterial & Venous Ulcers A Comprehensive Review Assessment & Management 1 Objectives Understand Arterial & Venous disease Understand the etiology of lower extremities ulcers Understand assessment of lower
More informationA systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes
DIABETES/METABOLISM RESEARCH AND REVIEWS Published online in Wiley InterScience (www.interscience.wiley.com).825 REVIEW ARTICLE A systematic review of the effectiveness of interventions to enhance the
More informationORIGINAL ARTICLE. doi: /iwj.12600
International Wound Journal ISSN 1742-4801 ORIGINAL ARTICLE A prospective, randomised, controlled, multicentre clinical trial examining healing rates, safety and cost to closure of an acellular reticular
More informationHyperbaric oxygen therapy for chronic wounds(review)
Cochrane Database of Systematic Reviews Hyperbaric oxygen therapy for chronic wounds(review) KrankeP,BennettMH,Martyn-StJamesM,SchnabelA,DebusSE,WeibelS KrankeP,BennettMH,Martyn-StJamesM,SchnabelA,DebusSE,WeibelS.
More informationWound Dressing. Choosing the Right Dressing
Wound Dressing Choosing the Right Dressing Benefits of using the correct Drsg Helps create the optimal wound environment Increases healing rates Reduces pain Decreases infection rates Cost effective Care
More informationRegenerative Tissue Matrix in Treatment of Wounds
Regenerative Tissue Matrix in Treatment of Wounds Learning Objectives Differentiate between reparative and regenerative healing Review surgical techniques for applying a regenerative tissue scaffold to
More informationDRESSING SELECTION. Rebecca Aburn MN NP Candidate
DRESSING SELECTION Rebecca Aburn MN NP Candidate Should be individually tailored in conjunction with the patient to meet their individual needs. WOUND MANAGEMENT: Comprehensive health assessment Wound
More informationA systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes
DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2012; 28(Suppl 1): 119 141. Published online in Wiley Online Library (wileyonlinelibrary.com).2246 REVIEW ARTICLE A systematic review of
More informationComputerized planimetry evaluation of hyperbaric oxygen therapy in the treatment of diabetic foot
Original papers Computerized planimetry evaluation of hyperbaric oxygen therapy in the treatment of diabetic foot Marek Kawecki 1, 2, A, B, D, E, Jarosław Pasek 3, 4, A, C E, Grzegorz Cieślar 3, 4, D F,
More informationAgenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types. Summary
Dressing selection Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types Summary Which wound dressing poster Ref: Which wound dressing? Practice Nursing, September
More informationIntroducing A Scientifically Engineered Dressing That Provides Superior Wound Healing
Introducing A Scientifically Engineered Dressing That Provides Superior Wound Healing Fits The Wound Improves Patient Comfort Easy Application And Removal Introducing Altrazeal The Product Altrazeal is
More informationReview report of MTG5: The MIST Therapy system for the promotion of wound healing
Review report of MTG5: The MIST Therapy system for the promotion of wound healing Produced by: The Birmingham and Brunel Consortium External Assessment Centre Authors: Zulian Liu, Research Fellow, Institute
More informationHyperbaric oxygen therapy for chronic wounds (Review)
Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2005, Issue 4 http://www.thecochranelibrary.com
More informationAnseong Factory : 70-17, Wonam-ro, Wongok-myeon, Anseong-si, Gyeonggi-do , REPUBLIC OF KOREA
Care for tomorrow The Solution for Management HQ & Factory : 7, Hyeongjero4Beon-gil, Namsa-myeon, Cheoin-gu, Yong-in-si, Gyeonggi-do 449-884, REPUBLIC OF KOREA TEL: +8-3-33-33 / FAX: +8-3-33-34 Anseong
More informationSetting The setting was a hospital. The economic study was carried out in the USA.
A cost analysis of a living skin equivalent in the treatment of diabetic foot ulcers Steinberg J, Beusterien K, Plante K, Nordin J, Chaikoff E, Arcona S, Kim J, Belletti D A Record Status This is a critical
More informationHyperbaric Oxygen: Putting Principles into Practice Session 245 Sunday, September 11 th 2011.
Session 45 Sunday, September 11 th 011 Session Overview Jeffrey A. Niezgoda, MD, FACHM, MAPWCA Statistics & Definitions Non Healing PVD Ulcer Oxygen & Wound Healing Advanced Modalities for Angiogenesis
More informationCase Study 2 - Mr J. Medical history
Case Study 2 - Mr J A 54 year-old male was referred to the podiatrist at Coast Provincial General Hospital Diabetic Clinic, for management of active foot disease. The patient s presenting complaint was
More informationA prospective randomised comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers
International Wound Journal ISSN 1742-4801 ORIGINAL ARTICLE A prospective randomised comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers Charles M Zelen
More informationUSWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential MEASURE STEWARD: The US Wound Registry [Note: This measure
More informationCurrent Concepts in Burn Rehabilitation
Current Concepts in Burn Rehabilitation 7 th Congress of the Baltic Association of Rehabilitation Tallinn, Estonia September 2010 R. Scott Ward, PT, PhD Professor and Chair Department of Physical Therapy
More informationLABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore for the required texts for this class.
LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS SPECIAL NOTE: This brief syllabus is not intended to be a legal contract. A full syllabus will be distributed to students at the first class session. TEXT AND SUPPLEMENTARY
More informationMedical Policy. MP Amniotic Membrane and Amniotic Fluid. Related Policies Experimental / Investigational Services
Medical Policy BCBSA Ref. Policy: 7.01.149 Last Review: 02/26/2018 Effective Date: 02/26/2018 Section: Surgery Related Policies 9.01.502 Experimental / Investigational Services DISCLAIMER Our medical policies
More informationThe Great Debate: Offloading Diabetic Foot Ulcers: TCC vs. CAM Walkers Gregory A Bohn, MD MAPWCA, ABPM/UHMS
The Great Debate: Offloading Diabetic Foot Ulcers: TCC vs. CAM Walkers Gregory A Bohn, MD MAPWCA, ABPM/UHMS Department of Surgery Central Michigan School of Medicine Tawas, Michigan Disclosures Medical/Scientific
More information