classification acute wound chronic wound - oud-studenten · chronic wound ychronic wound is defined...

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Edward Jamalu Product Management BELGIUM FEDERATION OF WOUND CARE OCTOBER 12 TH 2010 Indonesia at A Glance Indonesia at A Glance y Islands : 17.508 islands y Wide Range : 1.904.569 km sq y Population : 237.556.363 person (More 50% in Java) y Density : 124 person/ km sq y GDP Average : $ 3,979/ yr € 3,000 € 3,200 € 3,400 € 3,600 € 3,800 € 4,000 € 4,200 € 4,400 MARKET SITUATION ON IPAIHPA (NON IDA): VALUE TREND OF FIRST LINE WOUND CARE 2008 2009 2010 Gr. 10.30% Gr. 8.28% IPA –IHPA = Indonesian Pharmaceutical Audit – Indonesian Hospital Pharmaceutical audit. IDA = Indonesian Drugstore Audit. (/1000) MAT Q2 MARKET SITUATION (VALUE): BASED ON IPAIHPA MAT Q2 2010 (NON IDA) V ALUE MS % GR % VALUE MS % GR % V ALUE MS % GR % VALUE 1 SELECTED TOTAL 1,172,755 100.00 11.90 4,197,567 100.00 10.30 3,805,600 100.00 8.28 3,514,590 1 BETADINE MKB 536,080 45.71 15.85 1,795,288 42.77 2.65 1,748,866 45.96 20.39 1,452,642 2 DARYANT-TULLE D.V 125,365 10.69 29.94 441,121 10.51 -2.09 450,557 11.84 60.62 280,516 3 BIOPLACENTON KLB 124,431 10.61 -2.98 499,273 11.89 0.10 498,767 13.11 32.11 377,551 4 SOFRA-TULLE S.A 101,141 8.62 56.57 318,090 7.58 119.90 144,650 3.80 -63.79 399,460 5 MEBO COM 89,743 7.65 55.75 324,295 7.73 39.05 233,219 6.13 134.58 99,421 6 BURNAZIN D.V 64,742 5.52 -32.47 247,232 5.89 15.43 214,190 5.63 93.94 110,442 7 MADECASSOL CRA 54,926 4.68 -1.00 228,947 5.45 -9.16 252,024 6.62 -6.67 270,049 8 ISODINE MKB 26,180 2.23 -43.36 146,005 3.48 1.35 144,061 3.79 -45.22 262,977 9 SANOSKIN OXY IBT 16,448 1.40 160.91 54,240 1.29 732.92 6,512 0.17 999.00 - 10 CERPLAST G2P 11,852 1.01 5.90 61,900 1.47 78.58 34,663 0.91 581.67 5,085 11 SANOSKIN M.DERM + IBT 8,375 0.71 34.55 29,030 0.69 358.96 6,325 0.17 999.00 - 12 DERMAZIN LEK 6,680 0.57 -41.07 29,084 0.69 -36.23 45,610 1.20 -69.27 148,423 13 BETADINE FOR KIDS MKB 3,414 0.29 57.02 10,777 0.26 -11.07 12,119 0.32 -18.77 14,919 14 SOLCOSERYL SLC 3,378 0.29 -4.62 12,285 0.29 -12.48 14,037 0.37 -84.92 93,106 MAT Q2 09 MAT Q2 08 RANK Q2 10 PROD DESC Q2 10 MAT Q2 10 MAT = Moving Annual Trend MS = Market Share, GR = Growth Value vs Value Last Year Classification yAcute wound yChronic wound

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Page 1: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Edward JamaluProduct Management

BELGIUM FEDERATION OF WOUND CAREOCTOBER 12TH 2010

Indonesia at A Glance

Indonesia at A Glance

Islands : 17.508 islandsWide Range : 1.904.569 km sqPopulation : 237.556.363 person 

(More 50% in Java)Density : 124 person/ km sqGDP Average : $ 3,979/ yr

€ 3,000 

€ 3,200 

€ 3,400 

€ 3,600 

€ 3,800 

€ 4,000 

€ 4,200 

€ 4,400 

1 2 3

MARKET SITUATION ON IPA‐IHPA (NON IDA):VALUE TREND OF FIRST LINE WOUND CARE

2008 2009 2010

Gr. 10.30%

Gr. 8.28%

IPA –IHPA = Indonesian Pharmaceutical Audit – Indonesian Hospital Pharmaceutical audit. IDA = Indonesian Drugstore Audit. (/1000)

MAT Q2

MARKET SITUATION (VALUE):BASED ON IPA‐IHPA MAT Q2 2010 (NON IDA)

VALUE MS % GR % VALUE MS % GR % VALUE MS % GR % VALUE

1 SELECTED TOTAL 1,172,755€ 100.00 11.90 4,197,567€ 100.00 10.30 3,805,600€ 100.00 8.28 3,514,590€ 1 BETADINE MKB 536,080€ 45.71 15.85 1,795,288€ 42.77 2.65 1,748,866€ 45.96 20.39 1,452,642€ 2 DARYANT-TULLE D.V 125,365€ 10.69 29.94 441,121€ 10.51 -2.09 450,557€ 11.84 60.62 280,516€ 3 BIOPLACENTON KLB 124,431€ 10.61 -2.98 499,273€ 11.89 0.10 498,767€ 13.11 32.11 377,551€ 4 SOFRA-TULLE S.A 101,141€ 8.62 56.57 318,090€ 7.58 119.90 144,650€ 3.80 -63.79 399,460€ 5 MEBO COM 89,743€ 7.65 55.75 324,295€ 7.73 39.05 233,219€ 6.13 134.58 99,421€ 6 BURNAZIN D.V 64,742€ 5.52 -32.47 247,232€ 5.89 15.43 214,190€ 5.63 93.94 110,442€ 7 MADECASSOL CRA 54,926€ 4.68 -1.00 228,947€ 5.45 -9.16 252,024€ 6.62 -6.67 270,049€ 8 ISODINE MKB 26,180€ 2.23 -43.36 146,005€ 3.48 1.35 144,061€ 3.79 -45.22 262,977€ 9 SANOSKIN OXY IBT 16,448€ 1.40 160.91 54,240€ 1.29 732.92 6,512€ 0.17 999.00 -€

10 CERPLAST G2P 11,852€ 1.01 5.90 61,900€ 1.47 78.58 34,663€ 0.91 581.67 5,085€ 11 SANOSKIN M.DERM + IBT 8,375€ 0.71 34.55 29,030€ 0.69 358.96 6,325€ 0.17 999.00 -€ 12 DERMAZIN LEK 6,680€ 0.57 -41.07 29,084€ 0.69 -36.23 45,610€ 1.20 -69.27 148,423€ 13 BETADINE FOR KIDS MKB 3,414€ 0.29 57.02 10,777€ 0.26 -11.07 12,119€ 0.32 -18.77 14,919€ 14 SOLCOSERYL SLC 3,378€ 0.29 -4.62 12,285€ 0.29 -12.48 14,037€ 0.37 -84.92 93,106€

MAT Q2 09 MAT Q2 08RANK Q2 10 PROD DESC

Q2 10 MAT Q2 10

MAT = Moving Annual TrendMS = Market Share, GR = Growth Value vs Value Last Year

Classification

Acute woundChronic wound 

Page 2: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Chronic WoundChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrenceTrapped in an ongoing inflammatory phase

Fowler E. Chronic wounds: an overview. In: Krasner D, editor.Chronic wound care: a clinical source book for healthcareprofessionals. King of Prussia, PA: Health Management Publications,Inc; 1990. pp. 12‐8.

Chronic woundCommon cause 

Venous stasisDiabetes mellitus Pressure necrosisIschemia

Other cause Malignancy VasculitisPyoderma gangrenosum

Assessment & Wound CareJakarta (Cipto Mangunkusumo National General Hospital is An Ideal Model)

Vascular Surgeon making assessment of wound and consult  to Endocrinologist (Diabetic patient), Orthopedic if need amputation, Plastic Surgeon (Skin Graft and flap), Neurologist or Pediatric (as a Team) and nurses take over  wound care of patient supervised by Vascular Surgeon

Big Cities (Surabaya, Medan, Bandung, Makassar, Manado etc)Assessment is done by Specialist/ GP‐ER who is caring patient and sometime consult to Plastic or vascular surgeon (as a team) but nurses take over wound care of patient supervised by the doctor

Small Cities/ VillageWound care is done by GP‐ER and Nurses or only nurses

Nursing EducationStart from 18 yo (after High School) and take 3 years (Academy)Method: Theory lesson and practical/ hands on start from 1st year90% female nurses and 10% male nursesHave Nurse Organization/ UnionHave A Special Organization for nurses that work at Surgeon Room (HIPKABI), under supervised by Indonesian Surgeon Association (PABI)HIPKABI gave them Training & Workshop about Wound care,  continuously.

Management

Management of UlcersWound Care

DebridementWound cleansingDressings ( Moist)Adjuvant therapies

Pressure reductionOr it will not heal

Risk factors addressedContinence careNutritional improvementMobility

Consider operative repair

Page 3: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

BasicsOptimize systemic parametersDebride nonviable tissueReduce wound bioburdenOptimize blood flowReduce  edemaUse dressings  appropriatelyUse pharmacologic  therapyClose wounds with grafts/flaps  as  indicated

Optimize systemic parametersAge: cannot be reversed, usage of growth factors, aggressive optimization of systemic parameters & supplementation.Avoidance of ischemia & malnutrition.Correction of diabetesAvoidance of steroids, alcohol, smoking.Avoidance of reperfusion injury: total contact casting, compression therapy.

Debridement & Reduction of Bioburden

Surface irrigation with saline.Debridement: surgical, enzymatic (papain with urea, collagenase), mechanical (pressurized water jet), autolytic, maggots.Antibiotics: cellulitis, decreased rate of healing, increased pain, straw colored oozing from skin, contaminated wounds, mechanical implants.Removal of FB.

Recent DevelopmentsHoney Product in  leg ulcers.Hydrogel in deep 2nd deg burns.LASER therapy enhances tissue repair?Nitric oxide containing nanoparticles

Focus on Diabetic Wound

Diabetes in Indonesia WHO: 2007: Indonesia is 4th Rank in the world of Diabetic Patient  (After USA, India and China)2000 : 8.4 Million Diabetic patient2007:  11 Million Diabetic patient2030:  22 Million Diabetic patient (11% of population)

Page 4: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Co‐Morbidity in Diabetes

Peripheral vascular disease occurs in 11% of diabetic patientsPeripheral neuropathy occurs in 42% of diabetic patientsPVD is associated with delayed ulcer healing and increased rates of amputation

Treatment of DU:What Works

Must surgically debride ulcer to allow healing: the wound edges are deadWeekly debridement down to healthy bleeding tissue gives best resultsMust keep pressure off the ulcers to allow healing

Pressure Reduction Off DUOrthopedic shoes: drop recurrence rate from 83% to 17%SandalsSplintsCrutches/wheelchairsTotal contact casting

Diabetic Gangren

Honey Base Product For Wound Care 

Received US Federal Drug Administration approval in 2007Anti‐inflammatory and Anti‐bacterial effects without antibiotic resistancePromote moist wound healingLow pHFacilitate debridement

Therapeutic Effects of Honey Dressings

2Antimicrobial

31Anti-inflammatory Debridement

4ReducesMalodour

5Promoteshealing

6Scarlesshealing

Pieper B, J Wound Ostomy Continence Nurs 2009; 36(1): 60‐6

Page 5: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Female,56thBlood pressure: !40/100ABI Right: 1Left: 0.6Albumin: 2.8

Pre op IGD 27.3.2010

Post Debri IGD 30.3.2010  Post Re debri IBP 16.4.2010

Post Re Debri IBP 2.5.2010Post STGS 6.5.2010

Page 6: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

FemaleBlood pressure: 120/80

ABI Right:1.08Left:1.08

Albumin: 3.0

Pre Op,March 10th

Post Debridement,March 13th Post STSG ,March 21th

FemaleBlood pressure: 150/80

ABI Right:0.91Left:1.0

Pre Op, March 10th 

Page 7: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Post Op March 18th Post STSG April 15th

Male50 yo

Blood pressure: Normal

First Come

After 2 weeks Wound Care After 4 weeks Wound Care

Page 8: Classification Acute wound Chronic wound - Oud-studenten · Chronic Wound yChronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence

Summary

Wound Care Management is good enough but Health service and human resources must be improvedThe risk factors  must be evaluated by the doctor especially in diabetes patientModern wound care products are being used more and more in modernwound care (Sanoskin)

Bunaken Sea Park, Manado, North Sulawesi, Indonesia