All types of wound care providers are vital to the goals, objectives and the
principles on which this Association was founded.APWCA is the leader in promoting a synergistic quality that represents best
practice and best outcomes for wound care patients. So join with our Board
of Directors who have committed to bringing in at least one new member this
year. There is not a more cost effective organization in wound care: providing
terrific education, provider and patient advocacy, representation to insurance
carriers, coordinating members to provide medical relief in Haiti, and so much
more!! So
help us help you!!
As we continue to
grow we have increasing ability to provide more services and address more of
your needs toprovide best care and
be reimbursed properly. Sit back and enjoy catching up on APWCA through this
eMail News Update.
CPT codes finally included for the Application of below knee
multi-layer venous wound compression system
Marcia Nusgart, RPh, APWCA member reports that the AMA recently
released its CPT codes, and finally the code for "Application of multi-layer
venous wound compression system, below the knee" was included. The code is
29581 and will be in effect January 1, 2010. The 29581 CPT code was assigned
to an APC group 0058 which has a reimbursement rate of $71.03 for 2010.
This is certainly good news and as reported in previous eMail News
Updates has been something which APWCA has worked on for the past several years
along with the Alliance of Wound Care Stakeholders for which Ms. Nusgart serves
as executive director. We all thank and congratulate the Society of Vascular
Surgeons (SVS), who submitted the application, for their leadership and to all
others involved.
APWCA
believes our next challenge will be to ensure that the Medicare MACs are
knowledgeable about this new code. Look for a more detailed article on this in
the next APWCA eMail News update.
APWCA
welcomes the American College of Hyperbaric Medicine (ACHM)
April 8-11, 2010 – Philadelphia, PA
Have you registered for the meeting yet?Here is your opportunity to gain 30 CME/CE Credits atReduced Rates.Rate
increases start February 23.
Register early to obtain best course selection as some have limited seating and
be sure to secure your hotel registration in the conference hotel!As a member, you save up to $140 in a full conference package.
For
information, lecture schedule and registration and hotel links:
For Hotel Room
Registration at the Sheraton Conference Hotel
click here.
Register today and save. Early Bird Rates
end Feb 22 Remember: Thursday Evening Lectures and Dinner Symposium are at NO
ADDITIONAL FEE!
Earn Additional CME/CE with great
lectures and a terrific dinner symposium, open to ALL Preconference and/or
General Session Registrants. The Dinner Symposium will sell out so register
Early to Secure your seat for a terrific, interesting and social evening!Have an opportunity to network with fellow colleagues and listen to over
40 faculty members, internationally renowned for their expertise in wound care.
Darlene
McCord, Ph.D., FAPWCA, will be busy at the 2010 APWCA Conference Darlene McCord will be featured at a
signing of her book, “Living Well at One Hundred�; her company, Pinnaclife,
Inc., will host an exhibit booth, and she will moderate the Annual
Scientific Address.
Dr. McCord’s book combines her personal
and professional perspectives on good health and healthy aging.
It offers a simple, straightforward
approach to living well into your later years by achieving wellness and
avoiding illness. To learn more and to read excerpts from “Living Well at One
Hundred,� visit
http://www.LivingWellatOneHundred.com. The book is available to purchase
through that site or at www.Amazon.com and
www.BarnesandNoble.com.
APWCA's past President Robert Gunther,
DPM, FAPWCA, and his wife Linda will join the Pinnaclife team at their exhibit
booth throughout the conference. Dr.
McCord and her husband founded the company in 2008.
Based in Coralville, Iowa—in the heart
of the Midwest—Pinnaclife is a nutritional supplement company built upon Dr.
McCord’s well-known Olivamine®. Olivamine
is also found in the Remedy medical skin care brand that currently enjoys the
number one position in the hospital and long�term care markets.
To learn more about Pinnaclife, visit
http://www.pinnaclife.com.
From 2 to 3 p.m. on Saturday, April 10,
Dr. McCord will moderate the Annual Scientific Address. APWCA Executive
Director Steven Kravitz, DPM, FAPWCA, will discuss “Can We Slow Skin Aging
Process? How does that Effect Disease?�
This is the largest APWCA meeting to
date providing a comprehensive picture with a full scope of practice options,
patient treatment and management concepts for best practice and business that
matters covering and coding and billing aspects of daily practice. The
conference is designed to be immediately applicable to daily practice.
TIP: Register early as preconference
courses all have limited seating! Be sure to check out the wide selection
of Pre Conference Courses that will fit the needs and interests of anyone in
wound care... from the provider new to those with years of experience.
Congress resumes sessions this week after the
historic closing of Washington, DC from all but emergency business due to one
week of two record breaking back to back snow storms. We are looking for
Congress to stop the 21.2-percent Medicare fee reduction that is scheduled to
start on March 1, when the 2-month freeze at 2009 rates expires. The Senate a
few weeks ago already extended the freeze until October 1. We are monitoring
and will keep you posted. There is no doubt or at least no doubt by APWCA that
the short term extensions to prevent the fee reduction does not resolve the
problem. There at some point needs to be a consensus to address this with a
more permanent approach that deals key issues rather then this “patch�
approach.
We are not alone. Other medical groups have been in the news expressing a
similar viewpoint.
Information is
also available by contacting the APWCA offices at
wounds@apwca.org or 215-942-6095.
CMS Issues "Various OIG Reports That Have Medical Review Implications"
On January 15, 2010, CMS issued a transmittal on "Various
OIG Reports That Have Medical Review Implications, "which provides instructions
to contractors to take steps to strengthen program safeguards to prevent
improper payment for areas identified by the OIG. Reports highlighted by
CMS include the OIG's reports on "Inappropriate Medicare Payments for Pressure
Reducing Support Surfaces" and "Comparison of Prices for Negative Pressure
Wound Therapy Pumps." CMS instructs contractors to use the information
contained in the OIG reports and follow the processes and procedures already in
the Medicare Program Integrity Manual concerning data analysis, contractor
strategies, and the progressive corrective action process. The
transmittal is posted
here.
Medicare Payment Advisory Committee (MEDPAC) - MedPAC Recommendations for Home
Health and Skilled Nursing in its March 2010 Report to Congress
Home Health Recommendations:
•Home health agencies will not receive
a payment update for fiscal year 2011 under a Jan. 14 recommendation by the
Medicare Payment Advisory Commission (MedPAC).In a series of unanimous
recommendations, commissioners voted to eliminate the marketbasket payment
update for the provider group next year while requiring the Department of
Health and Human Services to rebase home health's base payments to better
reflect the cost of providing care.
•
Commissioners also said that fraud and abuse in home health needs to be
addressed more aggressively. Currently, Medicare lacks the authority to stop
enrolling providers when fraud accelerates in areas with known risks. Several
patterns, including geographic variation in home health use, suggest that
increased scrutiny is necessary, commissioners said, echoing results published
in a MedPAC report released in December 2009 (229 HCDR, 12/2/09). •
Commissioners also recommended that the HHS secretary modify the home health
prospective payment system to create a financial safeguard that would protect
home health beneficiaries from provider stinting or giving a lower quality of
care in response to the payment rebasing.
•HHS identify the groups of
beneficiaries most likely to benefit from home health care and develop outcomes
measures for quality of care.
•Centers for Medicare & Medicaid
Services to review home health agencies that exhibit unusual patterns of claims
for payment. The recommendation also called for Congress to provide additional
authority to implement safeguards, like a moratorium on new providers or a
suspension of prompt payment, in areas that appear to be at high risk for
fraud.
Skilled Nursing Recommendations:
•MedPAC commissioners also voted to
eliminate the fiscal 2011 marketbasket update for skilled nursing facilities
(SNFs).
Haiti Volunteer Project We have 60
responders as volunteers to travel to and provide relief services for wound
care. We are working jointly to support efforts put together by Dr. Robert
Kirsner through the University of Miami. Our volunteer are in the process of
filling out the required material with Dr. Kirsner and the Department of
Homeland Security.Additional
members that may want to volunteer can click here.
Taiwan – Asian trip planning meeting during APWCA2010
APWCA members
interested in the APWCA follow up trip to Taiwan: APWCA2010 will host a
planning meeting. Time table for venue, July 2010 or Sept-Oct 2010.
Conference
Registrants interested in attending a planning session should contact APWCA at
215-942-6095 or Wounds@apwca.org.
Israel Joint Conference
Early planning discussion, Conference Registrants interested in attending a
planning session should contact APWCA at 215-942-6095 or
Wounds@apwca.org
Website Member Directory To Go LIVE ONLINE the end
of February Update your Online profile if you have not already accomplished
this
APWCA Membership Directory is operational, currently running in the background
and hidden on the website. We have automatically entered your contact
information based on your existing membership profile. Before we open for
access, we need to make sure that the data for each member is correct and that
members have the ability to participate or drop out and not be listed.The default is to opt out and therefore
any member not contacting the site to
confirm or update and correct their profile will NOT be listed in the directory.We are asking ALL members to take just a few minutes and modify
and/or correct as appropriate their contact information and select how their
information will be used.
There are three options:
Participate
with Access to Public at Large & Membership
Participate with Access to Membership Only
Opt-Out and not participate with the directory (This is the Default)
Following over a year and a half of effort, the SCALE Panel is pleased to
announce the release of the Skin Changes At Life’s End (SCALE) Final
Consensus Statement. An international panel of 18 members developed the
document that was then peer reviewed by 51 Distinguished Reviewers from around
the world. The final document went through a modified Delphi process and
has been submitted for publication to wound, geriatric and hospice journals.
The SCALE Final Consensus Statement and an Annotated Reference List can be
downloaded free of charge from: www.gaymar.com
> Clinical Support and Education > SCALE Consensus Documents
Please share this important document with colleagues and stakeholders.
Many clinicians rely exclusively on clinical acumen when determining how to
manage chronic wounds. Though an ulcer’s clinical features may be fairly
indicative of its etiology, in some instances, such is not the case. Even among
the most characteristic-appearing ulcerations, masqueraders do exist.Ruling out the possibility of an unsuspected neoplastic or inflammatory
condition could be necessary for the successful management of chronic wounds.In this context, cutaneous biopsy techniques may be invaluable; however,
their utility does not necessarily end here.
There are three common clinical settings in which a biopsy may be used in the
management of a chronic wound. Clinicians may use histopathology to 1) confirm
a clinically suspected diagnosis at the outset of care, to 2) rule out a mimic
in cases where a wound is showing recalcitrance or unusual progression, to 3)
assess for an underlying predisposing condition independent of the ulceration,
or to 4) assess for compounding feature, such as an excessive bacterial burden.Because the clinical presentation of cutaneous ulcerations may be
virtually pathognomonic of a particular etiology, the first of these scenarios
should not always give rise to a biopsy; however, in some instances,
confirmation is warranted.In a
minority of cases, the clinical manifestations that surround an ulceration are
entirely nonspecific and a biopsy is indicated prior to the initiation of
medical care.
For wounds that appear characteristic of a particular etiology, biopsies are
usually not initially necessary; however, as a rule of thumb, biopsies should
be considered for all ulcers that cannot be readily explained or fail to show
improvement after 2 months of treatment. In instances such as this, biopsies
are being used to verify that the implemented therapeutic regimen is
appropriate. Delays in the diagnosis of some mimics may be medicolegally
treacherous. For instance, malignant melanoma, particularly amelanotic
variants, may create ulcers that are virtually identical to non-neoplastic
ulcers. Delays in this diagnosis may have serious implications with regard the
affected patient’s outcome.
Simply stated, the failure to reassess ones differential diagnosis in cases
where ulcerations show unusual clinical behavior, or recalcitrance, is may be a
direct cause of increased morbidity.
An additional clinical setting where a biopsy might prove useful in the
management of chronic wounds, involves patients with suspected neuropathy as a
predisposing condition. With a 3mm punch biopsy of skin, taken for 10 cm above
the lateral malleolus, physicians may qualify and quantify the presence of
small fiber neuropathy. Degenerative changes among the intra-epidermal nerves,
may further be to predictive of the future onset of small fiber neuropathy.
Though this examination uses a simple 3mm punch of skin, there are differences
in the handling of biopsies taken for this purpose. Most important among these
differences are that punches taken for epidermal nerve fiber density testing
require a specialized fixative that must be requested from the lab, and care
must be taken to avoid crushing the surface epithelium when removing the tissue
from the biopsy site. Formalin fixative renders the biopsies useless for small
fiber analysis.
In most instances, the biopsy technique of choice for verifying the cause of an
ulceration, assessing for neoplastic and non-neoplastic mimics, and
characterizing predisposing conditions, is a punch biopsy.
In the initial two settings, a central and peripheral 3mm punch is usually
sufficient; however, the identification of vasculitis may require additional
random punches in hopes of sampling an effected vessel. As aforementioned,
epidermal nerve fiber density analysis requires the same 3mm punch taken at
10cm above the lateral malleolus. To document length dependence, (as would be
expected in bona-fide cases of small fiber neuropathy), clinicians may also
perform a punch biopsy on the ipsilateral side, 10cm distal to the greater
trochanter of the femur.
Biopsies are not a silver bullet in the management of ulcerations; however,
clinicians should keep them in mind when the indications present themselves.
Not uncommonly, these techniques make all the difference!
Update from The Effect of Blood Sugar Control on Healing
Diabetic Foot Ulcers
Nancy Collins, PhD, RD, LD/N, FAPWCA; and Liz Friedrich, MPH, RD, LDN
The relationship between nutrition and wound healing is well recognized by the
health care community. Today, registered dietitians (RDs) are included as
members of the wound care team in most facilities to assure optimal nutritional
interventions for both prevention and healing. However, the focus is most
frequently on pressure ulcers, particularly in long-term care. While nutrition
professionals have become quite familiar with interventions for this type of
wound, many other types of skin integrity issues exist, including foot ulcers
caused by diabetes. A thorough understanding of the relationship between
diabetes and wound healing is essential, so that nutrition professionals can
contribute to the management of this type of wound as well.
Phases of Wound Healing
Wound healing occurs as a cellular response to injury and involves the
activation of many different cell types.(1) A variety of growth factors and
cytokines released by these cells are needed for wound healing. Some key
components involved in wound healing are outlined in Table 1. Wounds heal in
three phases. The first phase, inflammation, involves vasoconstriction of small
blood vessels, and an influx of inflammatory cells and plasma proteins to
mediate cellular repair. The second phase, proliferation, involves fibroblastic
activity and angiogenesis by endothelial cells. During this phase, granulation
tissue is generated. The third phase is maturation, where collagen synthesis
and breakdown occurs. This phase can last up to 2 years.(2)
When cells involved in any of these stages are impaired because of diabetes,
wound healing is impaired. According to one source, more than 100 different
physiological factors contribute to wound healing problems in people with
diabetes.(1)
Effects of Hyperglycemia
Hyperglycemia can affect wound healing, both long term and short term.
Uncontrolled blood sugar levels over time lead to peripheral neuropathy, which
is a cause of chronic foot ulcers. By one estimate, 20% to 49% of older adults
with diabetes have neuropathy, peripheral vascular disease, or both.(3) Those
with peripheral neuropathy lose feeling in their feet and hands. In the event
of a callous, scrape, or skin breakdown at a pressure point on the foot, the
patient may not notice the wound, because pain is not felt. Diabetic foot
ulcers, also known as neuropathic ulcers(4), rarely heal well and are
complicated by peripheral vascular disease or other circulatory problems. As
many as 15% of adults with diabetes will develop chronic ulcers during their
lifetime.(2)
Acute episodes of hyperglycemia, even in newly diagnosed patients with
diabetes, can make wound healing more difficult. Several cellular mechanisms
involved in wound healing are affected when blood sugar levels are high. For
example, granulocytes show impaired function in the presence of high blood
sugars, especially in the inflammatory phase of wound healing.(5) A delay in
the inflammatory response may prevent formulation of granulation tissue.(5)
Uncontrolled blood glucose also impairs blood flow through the microvascular
system at the wound surface by impeding red-blood-cell permeability, preventing
flow of oxygen and nutrients to the cells, and increasing cell wall
rigidity.(6) Experts agree that controlling blood sugar on a day-to-day basis
can help expedite wound healing. Unfortunately, no recommendations pinpoint a
certain blood glucose level or HbA1c level, which may contribute to impaired
wound healing.
In addition to the direct effect of diabetes on wound healing, individuals with
diabetes are at an increased risk of infection, because of decreased host
resistance. Infection can have a separate effect on blood sugar, resulting in a
delayed healing process.(6)
Nutritional Goals
Medical nutrition therapy for patients with diabetic foot ulcers should focus
on maintaining skin integrity and controlling blood sugar levels. Adequate
protein is necessary to support the growth of granulation tissue.(7) While
specific recommendations for nutrition care for patients with diabetic foot
ulcers are not available, it seems prudent to follow the general guidelines for
pressure ulcer healing. This includes 30-35 calories/ kilogram (kg) body
weight, 30 milliliters (mL) of fluid/kg body weight, and 1.2-1.5 grams (g)
protein/kg body weight. Comorbid conditions may affect these guidelines.
Dietitians should evaluate HbA1c levels, finger-stick blood sugar results, and
blood glucose levels, but use HbA1c as the primary target for glycemic
control.(8) Regular monitoring and evaluation of body weight trends, meal
consumption, lab values, and the wound healing progress are essential.
Dietitians should use clinical judgment to modify the nutrition plan of care
based on these findings.
When treating patients in long-term care, the goals may differ from those for
younger patients in an acute or rehabilitation setting. Clinicians are divided
on the degree of aggressiveness for managing blood sugar levels. Older adults
who are functional, cognitively intact, and have significant life expectancy
should use treatment goals for diabetes that are designed for younger
adults.(8) These guidelines are outlined in Table 2 and suggest a target HbA1c
of < 7%. For institutionalized older adults with a life expectancy of <5 years,
a target HbA1c of 8% sometimes is more appropriate.(3) However, according to
the 2009 Standards of Medical Care In Diabetes,
attempts to control blood sugars are necessary if patients experience side
effects such as dehydration or poor wound healing, even in those individuals
with life-limiting illnesses or substantial cognitive impairments.(8)
Achieving glycemic control in long-term care patients often is difficult. Frail
elderly patients sometimes are unwilling or unable to comply with medical
regimens. Acute infections such as urinary tract infections, which are common
in nursing home patients, may increase glucose levels.(3) Many commonly
prescribed medications can cause hyperglycemia, including thiazide diuretics,
antipsychotic agents, glucocorticoids, and megestrol acetate.(3) Reducing or
eliminating medications in an attempt to reduce hyperglycemia is not a
realistic approach for many patients.
Most experts agree that patients in long-term care are best treated by
modifying the dosages of oral hypoglycemic agents or by administering insulin,
rather than by mandating dietary changes. This is especially true for those
patients whose meal intake already is poor and may worsen by placing additional
restrictions on what foods are allowed. In most cases, a liberalized diet is
appropriate in long-term care, even in patients with elevated blood-sugar
levels. To maximize wound healing in patients with diabetes, the wound care
team must attempt to find a balance between medical necessity and quality of
life, and develop a plan of care for each patient that reflects that balance.
Table 1: Key Components for Wound Healing(2)
Component
Role in Wound Healing
Effects of Diabetes
Growth Factors
Examples:
·
Platelet-derived growth factor
·
Basic fibroblast growth factor
·
Nitric oxide
These are integral in the chemotaxis, migration, stimulation, and
proliferation of cells and matrix substances necessary for wound
healing
Altered secretion or absence of various growth factors in diabetic foot
ulcers can potentially impair wound healing
Cellular Activity
Examples:
·
Epithelial cells
·
Fibroblasts
·
Dendritic cells
·
Endothelial cells
·
T cells
·
Natural killer cells
·
Platelets
·
Macrophages
Many different types of cells migrate to the wound site to mediate the
inflammation, coagulation, and angiogenesis processes
Hyperglycemia changes structure and growth of cells, resulting in
impaired wound healing
Collagen
Collagen synthesis and degradation are critical to development of scar
tissue in the maturation phase of healing
In diabetes, collagen synthesis is markedly decreased, resulting in
impaired wound healing
Table 2: Summary of Glycemic Recommendations for Nonpregnant Adults With
Diabetes(8)
HbA1c
<7.0%
Preprandial capillary plasma glucose
70-130 milligrams (mg)/deciliter (dL)
Peak postprandial capillary plasma glucose
<180 mg/dL
Key concepts in setting glycemic goals:
·
HbA1c is the primary target for glycemic control
·
Goals are individualized based on:
–
Duration of diabetes
–
Age/life expectancy
–
Comorbid conditions
–
Known cardiovascular disease or advanced microvascular complications
–
Hypoglycemia unawareness
–
Individual patient considerations
·
More or less stringent controls sometimes are appropriate for
individual patients
·
Postprandial glucose sometimes is targeted, if HbA1c goals are not met
despite reaching preprandial glucose goals
References
1.
Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in
diabetes. J Clin Invest.
2007;117:1219-1222.
2.
Dinh T, Pham H, Veves A. Emerging treatments in diabetic wound care. Wounds [serial online].
2002;1. Available at:
www.woundsresearch.com/article/138.
Accessed April 1, 2009.
3.
American Medical Directors Association.
Diabetes Management in the Long-Term Care Setting: Clinical Practice
Guidelines.
Columbia, MD: AMDA; 2008.
4.
Takahashi PY, Kiemele LJ, Jones JP. Wound care for elderly patients: advances
and clinical applications for practicing physicians. Mayo Clin Proc.
2004;79:260-267.
5.
Lioupis C. Effects of diabetes mellitus on wound healing: an update. J Wound Care.
2005;14:84-86.
6.
Litchford MD. The Advanced Practitioner’s Guide to Nutrition and Wounds.
Greensboro NC: Case Software and Books; 2006.
7.
Steed DL, Attinger C, Colaizzi T, et al. Guidelines for treatment of diabetic
ulcers. Wound Repair Regen.
2006;14:680-692.
NYU School
of Medicine The Department of Surgery at NYU Langone Medical Center is
seeking to recruit a General Surgeon, for The Helen & Martin Kimmel Division of
Wound Healing & Regenerative Medicine under the direction and leadership of
Harold Brem, MD.
The Division of Wound Healing is seeking a general surgeon with an
exclusive practice for non-healing wounds for treatment of
long term non-healing surgical wounds, specifically pressure ulcers, venous
ulcers, diabetic foot ulcers. They will spend approximately three days a week
in main OR and one to two days in wound center.
Academic rank will be consistent with experience.
The Helen & Martin Kimmel Division of
Wound Healing & Regenerative Medicine is a highly academic practice and
environment focusing on Regenerative Medicine. It is a highly collaborative
group of general, plastic surgeons and vascular surgeons.
Interested individuals should send their CV to the Helen and
Martin Kimmel Program Manager Tracy Henry via email to tracy.henry@nyumc.org
Excellent Opportunity in Family and Outdoor Oriented Community The Wound Healing and Hyperbaric Center is seeking a dynamic,
highly motivated physician with wound care and hyperbaric certification to join
our IM/wound care/hyperbaric physician in a hospital-owned facility located in
Clarkston, WA, supported by two mono place hyperbaric chambers and serving an
existing regional patient base. FT clinic position includes consultations in
two local hospitals. Team approach in collegial medical community involving
many specialties. Innovative approaches, aggressive and proactive management of
problems involving the total patient health and a passionate and enthusiastic
staff.
Interested individuals please send CV to the Tri-State Wound
Healing and Hyperbaric Center via e-mail to:
LIMB PRESERVATION/PODIATRIC SURGEON POSITION AVAILABLE MADIGAN
ARMY MEDICAL CENTER, TACOMA, WA
Chief, Limb
Preservation Service:
The Vascular Surgery Service in the Department of Surgery at the Madigan Army
Medical Center is recruiting a Podiatric Foot and Ankle Surgeon to be Chief of
the Limb Preservation Service. Madigan Army Medical Center, a combined
inpatient and outpatient level II trauma center, is a comprehensive military
training facility in the Pacific Northwest serving active duty personnel,
military retirees, and family members. The Chief of the Limb Preservation
Service will be responsible for out-patient clinic and in-patient surgical
management of patients; Function as Director of the Council on Podiatric
Medical Education approved 2-year Limb Preservation Complex Lower Extremity
Surgery and Research Fellowship; Director of the 4th Year CORE Podiatric
Medical Student Education; Work in conjunction with the Vascular Surgery
Service and Wound Care Clinic; Educate rotating allopathic, osteopathic, and
podiatric medicine and surgery students and residents;Lecture to medical, surgical, and nursing departments;Coordinate, write, conduct, and present research;Promote evidence-based medicine to students, residents, fellows, and
attending physicians; and Provide national and international recognition for
the Madigan Army Medical Center. Patients with complex medical conditions
admitted for surgical intervention by the Limb Preservation Service are
medically co-managed with the Vascular Surgery Service, Department of Internal
Medicine, or Department of Family Medicine.
Compensation:
Salary commensurate with training and experience in a location with a modest
cost of living. Paid vacation; CME; sick leave; and medical malpractice
coverage provided at no cost.
Comprehensive health insurance is available at nominal cost.
Requirements: Completion of a 3-year residency; ABPS Board Qualified or
Certified; and Sound academic record.
FAX or EMAIL CV and letter of intent: Charles A. Andersen, MD, FACS; Chief, Vascular Surgery
Service; Fax: 253-968-5997; e-mail
Charles.Andersen@us.army.mil.
APWCA Patient Information Pamphlets
Brochures are available to distribute to patients, place in waiting
room, etc. They explain the benefits you as a provider offer patients
through your APWCA membership. These can be purchased through the APWCA at
a nominal fee of $30.00 per 100 copies (includes $25.00/100 plus $5.00 for
tax, shipping and handling). Charge card orders can only be processed
by phone or fax. Do not use email for credit card orders as our email
address is for our general box and is not secured. You will also have
availability to order the brochures on line through our website over the next
few weeks. Until then, drop us a line and call us or fax your request.
APWCA Lab Coat Patches are attractive color embroidered patches for
sleeve or front of lab coat with APWCA logo and the motto “Synergy
of Disciplines in Wound Care�. They are
to be sewn to the garment to ensure they are secured properly. Wear them
proudly to demonstrate your interest in wound care and your membership in this
Association to your peers and patients. The first patch is on us at no charge
or you can mail a check or charge $10.60 (includes handling, postage and tax)
payable to APWCA by phone or fax and we will mail you four patches.
APWCA Lapel Pins for sport coats and suit jackets as well as lab
coats. Our acronym, “APWCA� in center with the phrase “Synergy in Wound Care�
or “Synergy in Disciplines� peripheral around the pin border. They look great.
Wear the lapel pin proudly today. Be sure to pick up your pin at any
APWCA conference or related event. Check out the events schedule in this email
news update.
PowerPoint CD with nearly 100 word and picture slides,
“Fundamentals of Wound Care� is
available for your presentation to medical audience or your local general
community, hospital outreach clubs and more. $100.00 plus tax ($106.00) for
members and $250.00 plus tax ($265.00) for non-members. Allow 4 to 6 weeks for
normal delivery. 10 day turn around, an additional $25.00.
American Professional Wound Care Association certificate professionally framed
with superior quality materials ready for display!
Your choice of two attractive ways to have your credential framed and ready for
display.
The first is a traditional walnut burl with an inner gold edge made of a
composite material. The second produces a more contemporary look with a
brushed gold aluminum frame, approximately 19�w x 16� h. Neither frame
will warp, crack, or release harmful chemicals that may damage your
certificate. Both framing choices display your certificate, double matted
with acid free materials, glazed with plexi-glass and a wire attached for
immediate display.
The cost including shipping + 6% sales tax totals $275.00
We are proud to be
able to acknowledge all of the following:
The American
Professional Wound Care Association thanks the following exhibitors.
(The following list is
complete as of date of brochure printing.)
Emerald ...McCord Research
(Pinnaclife)
Platinum ...KCI
Medical Solutions Supplier
Medline Industries, Inc.
Gold ...Healthpoint, Ltd.
Organogenesis
Silver ...Amerx Health Care Corp.
Bako Pathology
Pamlab, LLC
Copper...Wright Medical
And Other exhibitors
American College of Hyperbaric
Medicine
BioMedix Vascular Solutions,
Inc.
Calmoseptine, Inc.
DM Systems
Electro-Medical/Assist Tables
ETC (Biomedical)
Koven Technology
Lippincott Williams & Wilkins-
Wolters Kluwer Health
NormaTec
Promedica International
Stratus Pharmaceutical Inc.
Synovsis Orthopedic & Wound Care
Inc.
Tekscan
APWCA appreciates all of these companies for their vision and support of the
APWCA educational goals and objectives. They have allowed this Association to
aspire and produce a gold standard, pace setting scientific program for 2010.
APWCA provides educational resources, provider advocacy, consultation services,
and advice and suggestions for the enhancement of practice and the business of
wound care. In that light, please note the available press release describing precautions that diabetic
patients should take to reduce their risk in these hot summer months.
The release is templated to include your name and allowing you to forward on to
local newspapes or other media. We are providing this in an MS Word
format giving members the ability to modify as required.
Download Now
Competitive Bidding
Delayed, Physician Payments Maintained, Severe Limitation on Ulcer Debridements
Reversed – and More! These are only a few of the many accomplishments for
which APWCA has had an active participatory role. It is why your membership is
important and the reason for our new membership drive. Increased membership
will provide greater visibility to CMS and insurance carriers. This will also
help to supply funding to support our very active Insurance Committee and
additional related staff. This will allow APWCA to
have an even greater voice and more significant influence to support the needs
of our membership and patient advocacy.
An APWCA White Paper – Now Available on our Website
This white paper provides
basic recommendations determined by an APWCA Committee and is based upon
committee and panel experience on establishing and maintaining a successful
wound center. Its purpose is to serve as a guideline around which further
thought and discussion should be held and is not designed to represent a
definitive treatise on the subject for any particular center. We want to
acknowledge the core committee and an additional 50 APWCA members who reviewed
the monograph and whose comments were incorporated into this document.
Annual membership fees can now be paid on our website at
www.apwca.org -
When you receive a copy of your dues notice remember payment online is
available.
Written by two well-known
wound care specialists and an interdisciplinary team of experts, this handbook
is essential for all professionals involved in wound care, including nurses,
physical therapists, physicians, podiatrists, and long-term care professionals.
The book provides practical, comprehensive guidelines for assessment and
management of both common and atypical wound problems and covers many topics
not sufficiently addressed in other texts, such as sickle cell wounds,
amputation, gene therapy, and the specific wound care needs of special
populations. Features include more than 100 photographs and illustrations,
recurring icons such as Evidence-Based Practice and Practice Points,
case studies, and review questions.
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