Here is a link to my presentation so far:
https://docs.google.com/presentation/d/1ekyxZNbTybRA82iFaXKhwl89mAH1mGokmrBbnLyzwm4/edit?usp=sharing
I am not quite finished with it yet, so I will post another entry next week with my finalized presentation.
I will also be going in next week for one more week because I missed a few days last week.
Monday, April 25, 2016
Friday, April 15, 2016
Week 10
Hello there!
Like last week, I did not go in to the clinic much this week. I got back Tuesday from my trip to Virginia, and Dr. Stein will be out of town this Thursday and next Monday. I was able to go in on Wednesday with Dr. Weiland, and I saw a few memorable patients, which I will talk about later in this post.
Because I was not able to go into the clinic much, I am almost finished with my analysis! I have yet to compare the data that I have collected with national data, but I calculated the percent closure of 10 wounds from different patients from visit to visit and the percent closure over the course of about 3 months. I also calculated the average percent closure over 3 months from all 10 patients. Although I initially had no idea how to use Excel, with the guidance of Mr. Loudenslagel, I realized that you can plug in a formula into a certain "cell" and copy and paste it to adjacent cells. This greatly increased my efficiency. Instead of using a calculator to calculate the percent closure from visit to visit and recording each data point, I simply inserted the formula ((Y1-Y2)/Y1)*100)-- the percent change formula. I was then able to copy the relationship between Y1 and Y2, and paste it to another set of data points. However, I did encounter one obstacle : I have an extreme outlier in my pool of data. And, as we've learned in Statistics, this would cause my study to be statistically insignificant. When I return to the clinic next week, I hope to find another patient to use, but for now I've calculated the average percent closure over 3 months for all 10 patients with and without the outlier.
The most memorable patient I saw this week was certainly a decubitus ulcer. These are most commonly known as a pressure ulcer or a bed sore. Decubitus ulcers are caused by prolonged pressure on a certain area of the body that causes damage to the tissue. So far the pressure ulcers I've seen are on the ankle or foot somewhere, usually in diabetic patients. They are also usually not as severe as other types of wounds.
The patient I saw had an incredibly severe decubitus ulcer. It was located on his lower back, and, Dr. Weiland told me that it used to be so severe that you could see the entire pelvic bone in the wound. Although it had apparently improved since last visit, it was still extremely large.
Hopefully next week I can finally finish my analysis!
Like last week, I did not go in to the clinic much this week. I got back Tuesday from my trip to Virginia, and Dr. Stein will be out of town this Thursday and next Monday. I was able to go in on Wednesday with Dr. Weiland, and I saw a few memorable patients, which I will talk about later in this post.
Because I was not able to go into the clinic much, I am almost finished with my analysis! I have yet to compare the data that I have collected with national data, but I calculated the percent closure of 10 wounds from different patients from visit to visit and the percent closure over the course of about 3 months. I also calculated the average percent closure over 3 months from all 10 patients. Although I initially had no idea how to use Excel, with the guidance of Mr. Loudenslagel, I realized that you can plug in a formula into a certain "cell" and copy and paste it to adjacent cells. This greatly increased my efficiency. Instead of using a calculator to calculate the percent closure from visit to visit and recording each data point, I simply inserted the formula ((Y1-Y2)/Y1)*100)-- the percent change formula. I was then able to copy the relationship between Y1 and Y2, and paste it to another set of data points. However, I did encounter one obstacle : I have an extreme outlier in my pool of data. And, as we've learned in Statistics, this would cause my study to be statistically insignificant. When I return to the clinic next week, I hope to find another patient to use, but for now I've calculated the average percent closure over 3 months for all 10 patients with and without the outlier.
The most memorable patient I saw this week was certainly a decubitus ulcer. These are most commonly known as a pressure ulcer or a bed sore. Decubitus ulcers are caused by prolonged pressure on a certain area of the body that causes damage to the tissue. So far the pressure ulcers I've seen are on the ankle or foot somewhere, usually in diabetic patients. They are also usually not as severe as other types of wounds.
The patient I saw had an incredibly severe decubitus ulcer. It was located on his lower back, and, Dr. Weiland told me that it used to be so severe that you could see the entire pelvic bone in the wound. Although it had apparently improved since last visit, it was still extremely large.
Hopefully next week I can finally finish my analysis!
Friday, April 8, 2016
Week 9
Hello there, and welcome to Week 9 of my Senior Research Project!
Unfortunately, I didn't go in to the clinic much this week, because Dr. Weiland is out of town. Also, I missed my Thursday rotation because I am currently in Virginia visiting University of Virginia and William & Mary! I did go in to the clinic on Monday, and was able to see the progress of a few of Dr. Stein's patients.
However, because I did not go into clinic much this week, I had time to start working on my retrospective analysis of the wound care data. I began by typing 3 months worth of data from 10 patients into Excel. From the data, I found the length and width of the wound, and was therefore able to find the total area of the wound. Therefore, I can see the area from visit to visit over a span of 3 months. I initially wanted to find the percent closure of the wound area from week to week, but realized that this would not be possible because, since the wound clinic is out-patient, many of the patients do not come in every week. Instead, I will be able to find the percent closure between visits for every patient.
Although nothing very memorable happened this week, I obviously need to incorporate another gross picture, because at this point my blog just wouldn't be the same without one! This week's infection is called "necrotizing fasciitis." Like last week, I personally haven't seen this type of wound in the clinic because it is so severe. You may have heard of "flesh-eating bacteria" which gained prevalence in the news a couple of years ago, and that is exactly what necrotizing fasciitis is: a severe bacterial infection that actually kills the body's soft tissue. This is all thanks to a strain of bacteria called "group A Streptococcus." Although there are more types of bacteria that can cause necrotizing fasciitis, group A Streptococcus is the most common.
Unfortunately, I didn't go in to the clinic much this week, because Dr. Weiland is out of town. Also, I missed my Thursday rotation because I am currently in Virginia visiting University of Virginia and William & Mary! I did go in to the clinic on Monday, and was able to see the progress of a few of Dr. Stein's patients.
However, because I did not go into clinic much this week, I had time to start working on my retrospective analysis of the wound care data. I began by typing 3 months worth of data from 10 patients into Excel. From the data, I found the length and width of the wound, and was therefore able to find the total area of the wound. Therefore, I can see the area from visit to visit over a span of 3 months. I initially wanted to find the percent closure of the wound area from week to week, but realized that this would not be possible because, since the wound clinic is out-patient, many of the patients do not come in every week. Instead, I will be able to find the percent closure between visits for every patient.
Although nothing very memorable happened this week, I obviously need to incorporate another gross picture, because at this point my blog just wouldn't be the same without one! This week's infection is called "necrotizing fasciitis." Like last week, I personally haven't seen this type of wound in the clinic because it is so severe. You may have heard of "flesh-eating bacteria" which gained prevalence in the news a couple of years ago, and that is exactly what necrotizing fasciitis is: a severe bacterial infection that actually kills the body's soft tissue. This is all thanks to a strain of bacteria called "group A Streptococcus." Although there are more types of bacteria that can cause necrotizing fasciitis, group A Streptococcus is the most common.
This picture isn't the greatest, but I can assure you I was being kind. If you're brave enough, you can do a Google image search of necrotizing fasciitis to see just how bad it can be.
Next week I'll be back in the clinic and will finish my analysis of the data! Until then!
Friday, April 1, 2016
Week 8
Hello again!
This week was very interesting, because it was the first week I saw how a doctor's schedule can change very easily. Unlike other jobs, a doctor's schedule is dependent on the number of patients rather than having specific hours. Therefore, the number of hours a doctor works can be very different from day to day. During my rotation in the Wound Clinic, the hours are pretty regularly 8:30 to 12:30. However, this week I stayed in the clinic a lot longer: the last day, I stayed in until around 2. Although I realize that this is still not an incredibly long time, it showed me that doctors' schedules can be very irregular.
I collected all my data this week, and can finally start with my analysis! I am planning on calculating the percentage of closure in the wounds' areas over 90 days, along with calculating the rate of closure from visit to visit.
And, finally, I know what you've all been waiting for; after all, my blog wouldn't be complete without a couple of gross pictures, right? I learned about a few more different kinds of wounds this week. Because the Wound Clinic is mainly out-patient (patients are not currently admitted to the hospital for treatment), this type of wound is not commonly seen there because it is so severe. However, along with seeing the progression of many of the patients this week, the doctors taught me a bit about "gangrene."
Gangrene is defined as dead tissue caused either by lack of blood flow or infection. Lots of the patients have venous insufficiency or an infection in their wounds, which can cause the tissue surrounding the wound to die. The medical term for this dead tissue is "eschar" and must be removed for the wound to heal. Below is a picture of gangrene:
This week was very interesting, because it was the first week I saw how a doctor's schedule can change very easily. Unlike other jobs, a doctor's schedule is dependent on the number of patients rather than having specific hours. Therefore, the number of hours a doctor works can be very different from day to day. During my rotation in the Wound Clinic, the hours are pretty regularly 8:30 to 12:30. However, this week I stayed in the clinic a lot longer: the last day, I stayed in until around 2. Although I realize that this is still not an incredibly long time, it showed me that doctors' schedules can be very irregular.
I collected all my data this week, and can finally start with my analysis! I am planning on calculating the percentage of closure in the wounds' areas over 90 days, along with calculating the rate of closure from visit to visit.
And, finally, I know what you've all been waiting for; after all, my blog wouldn't be complete without a couple of gross pictures, right? I learned about a few more different kinds of wounds this week. Because the Wound Clinic is mainly out-patient (patients are not currently admitted to the hospital for treatment), this type of wound is not commonly seen there because it is so severe. However, along with seeing the progression of many of the patients this week, the doctors taught me a bit about "gangrene."
Gangrene is defined as dead tissue caused either by lack of blood flow or infection. Lots of the patients have venous insufficiency or an infection in their wounds, which can cause the tissue surrounding the wound to die. The medical term for this dead tissue is "eschar" and must be removed for the wound to heal. Below is a picture of gangrene:
As you can see above, some of the toes are dead or dying. These toes most definitely would have to be amputated. If you refuse to read my blog again I completely understand.
That's all for this week, folks!
Friday, March 25, 2016
Week 7
Hello again and welcome back to my blog! It was great being able to see my sister for a week, but I was certainly eager to get back into the wound clinic, and I certainly have more stories to tell!
Many of the patients who come in to the wound clinic either have diabetic foot ulcers that do not heal because of neuropathy and lack of blood flow or venous stasis ulcers, which basically is caused by slow blood flow. This week there were very few diabetic patients, and many venous stasis patients, which is quite different from the other weeks I've been there. Interestingly enough, one of the most common treatments many of these patients were using is a common household item. In fact, you probably have it right in your pantry. Apparently, honey is an extremely effective would management option, and it's pretty cheap. Patients can go to Sprout's and buy something called "Medihoney" for $20 as compared to super expensive drugs.
Many of the patients who come in to the wound clinic either have diabetic foot ulcers that do not heal because of neuropathy and lack of blood flow or venous stasis ulcers, which basically is caused by slow blood flow. This week there were very few diabetic patients, and many venous stasis patients, which is quite different from the other weeks I've been there. Interestingly enough, one of the most common treatments many of these patients were using is a common household item. In fact, you probably have it right in your pantry. Apparently, honey is an extremely effective would management option, and it's pretty cheap. Patients can go to Sprout's and buy something called "Medihoney" for $20 as compared to super expensive drugs.
According to the doctors at the wound clinic, Medihoney has some of the same properties as silver (no germs can grow in it).
One of the most memorable patients this week was an older woman who had been coming in throughout the past 7 weeks with a non-healing surgical wound on her ankle from a bypass surgery and an ulcer on her toe. Although the wound on her ankle seemed to be healing, when she came in last week, the wound was nearly closed; however, this week, the wound had completely opened up again and was incredibly infected. The doctors initially assumed it was a fungal infection, because it looked rather similar to this:
A culture of the wound showed that she had a staph infection, which is bacterial rather than fungal. What was really interesting is that I was able to see the bypass put in her leg. It was not working anymore, which explain the lack of healing in both of her wounds: there was very little blood flow in those areas.
I also began my retrospective analysis this week! Mr. Loudenslagel and I went through some of the patients charts looking for diabetic foot ulcers, and he cut off identifying information. Therefore, I was able to take these charts home with me. So far, we have seven patients with diabetic foot ulcers. I would prefer to have 10 because it would make some of my calculations easier, so we are hoping to find 3 more charts.
That's all for this week! Stay tuned for next week for more information on my analysis.
Friday, March 18, 2016
Friday, March 11, 2016
Week 5
Hello again and welcome to week 5 of my blog!
This week I continued doing my rounds. I hope to start my retrospective analysis when I get back in to clinic in 2 weeks. This week was interesting, however, because I'm finally able to see progress in the healing of people's wounds. Chronic wounds are rather slow to heal, so it takes a few weeks to be able to see them heal. While some patients' wounds progressed in a positive way, others were not so lucky.
Many of the patients were discharged this week because they kept their feet elevated and wore their compression socks. The patient who had the old pace maker, which I talked about in another one of my blogs, has improved a lot. Although his wound still has a rather large tunnel leading towards his belly button, the opening is smaller and he was able to get his stitches taken out this week. Some of the other patients who had skin substitutes have also improved. One patient came in with a rather large ulcer on her leg, and Dr. Stein put dermapure, a donated skin collagen, to cover the wound:
She came back in to clinic this week and her wound was close to being completely closed! Some patients, however was not as lucky. Another patient had a wound near his ankle, and the doctor put dermapure on his wound. However, dermapure does not always take: the skin substitute did not properly integrate into the wound and became incredibly infected.
I also become rather familiar with the different drugs related to wound care. The doctors frequently prescribe genomycin, bactroban, lydocaine, iodosorbe, sylvadine, etc. However, the most frequent prescription continues to be elevation and compression.
Lots of the patients have actually know my name now, and it's great to walk into their rooms and be able to connect with the patient, which is one of the best parts about being a doctor, in my opinion.
I won't have a post next week, because I will be taking my spring break then, but stay tuned in 2 weeks for my next post!
This week I continued doing my rounds. I hope to start my retrospective analysis when I get back in to clinic in 2 weeks. This week was interesting, however, because I'm finally able to see progress in the healing of people's wounds. Chronic wounds are rather slow to heal, so it takes a few weeks to be able to see them heal. While some patients' wounds progressed in a positive way, others were not so lucky.
Many of the patients were discharged this week because they kept their feet elevated and wore their compression socks. The patient who had the old pace maker, which I talked about in another one of my blogs, has improved a lot. Although his wound still has a rather large tunnel leading towards his belly button, the opening is smaller and he was able to get his stitches taken out this week. Some of the other patients who had skin substitutes have also improved. One patient came in with a rather large ulcer on her leg, and Dr. Stein put dermapure, a donated skin collagen, to cover the wound:
I also become rather familiar with the different drugs related to wound care. The doctors frequently prescribe genomycin, bactroban, lydocaine, iodosorbe, sylvadine, etc. However, the most frequent prescription continues to be elevation and compression.
Lots of the patients have actually know my name now, and it's great to walk into their rooms and be able to connect with the patient, which is one of the best parts about being a doctor, in my opinion.
I won't have a post next week, because I will be taking my spring break then, but stay tuned in 2 weeks for my next post!
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