SAWC Spring 2012 Scholarship Winners

  This past March, the North American Center for Continuing Medical Education, LLC and the Symposium on Advanced Wound Care announced the inaugural class of five scholarship winners selected in cooperation with several prominent wound care societies and associations.   Recently, Today’s Wound Clinic took the time to chat with the winners to learn their views on the future of wound care and find out what led them into the industry.   Their bios are featured below. Bedside Share: Former ‘frontline’ nurse now provides wound care expertise from all angles. Clinician: Susan Girolami, BSN, RN, CWOCN Scholarship Award: Wound Care Nursing Scholarship Much has changed in the management and treatment of wounds since Susan Girolami earned her nursing degree and worked at the bedside on the “frontlines” of patient care in the early 1970s.   “The most relevant progress is that wound care has developed into a complex specialty practice deserving of increasingly formalized education programs and internships that will hopefully culminate in required levels of education for the wound care practitioner to ensure quality of care in both our inpatient and outpatient wound care practices,” said Girolami, who entered the wound care industry as a CWON in 1981. “The science of wound etiology, evolution, and response to treatment is a work in progress that has afforded vast amounts of information that has changed the face of wound care forever and will continue into the future. We have transitioned from heat lamps and random topical concoctions to more than 15 categories of dressing modalities that contain hundreds of product choices. Random practices are being replaced with evidence-based practices that correlate with clinical and diagnostic findings when formulating wound treatment programs. Interdisciplinary collaboration has increased for development of a comprehensive wound care program that enhances nutrition, offloading, management of comorbidities and psychosocial needs.”   Today, as wound care continues to evolve and generate better healing outcomes for patients, Girolami has seen her healthcare career come full circle as one who helps develop the very products that nurses and physicians utilize at the bedside while serving as a mentor and educator at the point of care.   “I feel like I’ve done it all — I’ve gone from providing acute care to consulting, education, and even compliance activities,” said Girolami, clinical manager with Therapy Support Inc., a healthcare provider and product manufacturer based in Cincinnati, OH, that produces specialty medical equipment and solutions to help clinicians improve outcomes and enhance quality of life for their patients. In her role, Girolami has a hand in product development, assisting in the designing of wound care products specific to offloading and pressure ulcer prevention, and serves as a wound consulting resource, meeting long-term care and hospice providers to give guidance on equipment, products, and services related to wound care. She also serves as a primary investigator for clinical efficacy, helping her company to ensure that governmental and Joint Commission compliance standards are met through clinical trials and infection control analysis.   “Our company works largely with hospice, home care, and long-term care,” said Girolami, who was named the SAWC’s “Wound Care Nursing Scholarship” winner in March and received her award at SAWC Spring in April. “We focus on providing quality care, comfort, and pain management at the end-of-life and for those patients living with chronic wounds or those at risk of developing pressure ulcers.”   Most recently, Girolami has been evaluating mattress and cushion designs for wheelchairs and recumbent systems that are in the clinical phase. As an educator, Girolami’s influence impacts decisions that wound care clinicians make when choosing appropriate equipment through the use of equipment algorithms that assist in devising care plans that provide the best methods of current treatment at the bedside based on each patient’s health status and state of wound healing. The insight she’s has gained from her position as an industry expert coupled with her clinical experience is invaluable to full-time practitioners who may not have the access to the most recent information available due to the ever-changing practices of healthcare in general.   Girolami said she’s taken the opportunities to broaden her wound care scope not just for education purposes but to improve bedside care. Though she’s not spending as much time as she once did at the bedside, Girolami knows her reach has been broadened, and that has made her impact that much more profound.   “I still interface with bedside nurses every day by helping them to make assessments at the bedside and set up care plans for wound management,” she said. “It’s providing one-on-one education and discussing appropriate plans of action for patient-centered care. After you work in various clinical settings, you become more educated through exposure to a wide array of wound experiences and can venture into other areas where you can help a larger population of patients by serving as a resource at the bedside. In today’s world, all healthcare is changing so rapidly that it’s tough to be a specialist on everything, thus professional collaboration in areas such as wound care optimizes quality of care.”   Girolami further adds to her influence through her responsibilities with the Association for the Advancement of Wound Care (AAWC), for which she’s served as co-chair of the guideline committee alongside fellow co-chair Laura Bolton, PhD, the last five years and sits on the organization’s task force for evidence-based guideline development. “As co-chair of the guideline committee for the AAWC, I am able to offer a great resource to nurses through sharing knowledge gained in the development of evidence-based guidelines with today’s paraprofessionals,” Girolami said.   She also brings that knowledge to SAWC symposiums. She attended her first event in the 1990s and was on hand for SAWC Spring 2012 in Atlanta, GA. As part of her scholarship, Girolami will receive free registration for a 2013 SAWC show of her choice.   “It’s always a valuable event because there are constantly new findings, products, and knowledge to be shared in the advancement of wound management,” she said of the SAWC experience. “If you’re in the wound care field the SAWC events are a great way to keep abreast of all the changes that have occurred in the previous year, and there always are changes. That’s what keeps wound care such an interesting practice. It is very much an honor to have been selected for this award.” --Joe Darrah Still Forming the Future: Once destined for another field of practice, one physician eagerly anticipates a further specialized future for wound care. Clinician: Jeffrey S. Danetz, MD, FACS, medical director of wound care at Edward White Hospital, St. Petersburg, FL; Largo (FL) Medical Center; and St. Petersburg (FL) General Hospital Scholarship Award: Wound Care Training Scholarship   If you asked him four years ago where he saw his career headed, Jeffrey S. Danetz, would likely have told you “vascular care and surgery,” unequivocally. At the time, Danetz had recently accepted his first position as a medical director in the wound care center at Edward White Hospital, St. Petersburg, FL. One who had long been devoted to the study of cardiovascular research since his days as a resident at the Medical College of Virginia in the mid-1990s, Danetz didn’t work in the field of wound care on a full-time basis until joining Edward White in 2008. Initially, he found himself working just one day with wound care patients, with the remainder of his time being focused on treating peripheral vascular pathology. But he’d soon come to realize that it was becoming increasingly obvious that his patients were experiencing better outcomes in limb salvage through the consistent (if not necessarily frequent) wound care he was conducting through the use hyperbaric treatment and other advanced modalities, as opposed to the results being experienced through revascularization procedures alone.   “As a result, my patient volume became more wound care related and there was a natural transition to focus more of my practice on inpatient and outpatient wound care,” said Danetz, who today oversees the wound care centers at two neighboring facilities in the Sunshine State. “I’ve essentially given up vascular practice other than conducting amputations and providing wound care.”   The somewhat sudden transition in practice can also be attributed to the quality of life he continued to see in his wound care patients who were able to maintain healthy lifestyles that concurrently aided their long-term recovery, Danetz said. “I love waking up in the morning, healing wounds, and helping grandparents get back to their grandkids,” he continued. “The impact you have on patients’ lives by healing their wounds through a multidisciplinary approach is overwhelmingly gratifying.”   “And we’re now seeing far better continuity of care,” Danetz continued. “But the real highlight of my role as a medical director in general is in getting the opportunity to spend time each week working with and training residents so that they can become better educated to improve the lives of the patients they care for.”   As a member of the inaugural group of clinicians that was awarded by SAWC’s scholarship program, Danetz also remains on the receiving end of wound care education. Through the funds he earned with his scholarship he was able to attend his first SAWC convention this spring. The benefits have quickly been realized.   “You realize you had attended a great conference when you return with more questions than you went in with and are even more inspired to care for your patients because of what you’ve learned, said Danetz. “We’re making great progress today in wound care, where in the past we would be seeing more amputations and late-stage, nonhealing wounds. Based on several of the presenters at SAWC, we have only traversed the tip of the iceberg. I’m very excited to learn what’s coming in the future, particularly with the prospects of being able to manipulate the microenvironment of a wound with specific management of individualized bioburdens, determining the specific deficiencies in growth factors, and imbalances of metalloproteinases.” --Joe Darrah A True Wound Healer: Through research, a physician is helping clinicians understand optimal wound healing. Clinician: Kenneth Finnson, PhD, Research Associate, Montreal General Hospital, McGill University Health Center, Department of Surgery. Scholarship Award: Wound Healing Research Scholarship   Determining the role that transforming growth factor beta (TGF-β) plays in cutaneous wound healing and scarring is currently a major undertaking by Kenneth Finnson and members on staff in the laboratory of Anie Philip, PhD, principle investigator at McGill University Health Center (MUHC) in Montreal. By specifically targeting burn patients and others who’ve experienced excessive scarring, Finnson and colleagues hope to learn the significance of trauma to the skin, secretion of TGF-β, presence of scarring as a result of TGF-β, and how excessive scarring can be decreased through the application of a novel TGF-β antagonist - CD109.   “Too much TGF-β can lead to excessive scarring, so CD109 may be applicable to treatment of excessive scarring such as in hypertrophic scarring or keloid formation where too much TGF-β is implicated, said Finnson, who’s dedication to the field of wound healing earned him a research scholarship from the SAWC in March 2012. He was nominated by Harriet W. Hopf, MD, past-president of the Wound Healing Society (WHS). “Our team has discovered that the molecular protein CD109 is a potent antagonist of TGF-β signaling and displays anti-scarring and anti-fibrotic properties in mouse models,” Finnson said. “We think our molecule will have application to wounds in which scarring is excessive. What we know so far is that CD109 interacts with TGF-β receptors and promotes degradation via the caveolar endocytosis pathway, which results in a decrease in TGF-β signaling. We also know that CD109 binds TGF-β directly and neutralizes its biological activity by preventing it from binding to its receptors.”   Thus far, Finnson and his colleagues, who include Philip, Albane Bizet (recent PhD graduate), Josh Vorstenbosch (PhD candidate), Carter Li (PhD candidate), Melani Lighter (recent MSc graduate), and Jean-Philip Lacroix (McGill resident) are finding that mice exposed to CD109 tend to have better heal outcomes, don’t experience as much scarring, and seem resistant to fibrosis. Finnson also said “discussions with companies and venture capitalists that are interested in purchasing the rights to a clinical trial for the patented research have already begun.” The pre-clinical phase of research is expected to be completed within the next two years.   It could very well be that some day Finnson, who not only attended the SAWC Spring 2012 show in Atlanta, GA, but gave a mini-symposium presentation on anti-inflammatory properties of CD109 in the skin, shares the full research findings with SAWC attendees. A regular WHS/SAWC attendee, he said he will be using his scholarship funding to attend the 2012 fall show in Baltimore, MD.   “The scholarship came as a complete surprise,” Finnson said. “It’s definitely a feather in our hat. It brings recognition for the work that we do. For me, just receiving the recognition is more important than the funding. That’s more fulfilling than the monetary part, but it’s very nice to get the funding to attend SAWC/WHS.” --Joe Darrah Educating the Educator: Chicago physician brings great educational opportunities to her students and residents, thanks in part to SAWC. Clinician: Malgorzata “Gosia” Plummer, MD, assistant professor of clinical surgery, wound healing and tissue repair, University of Illinois at Chicago Scholarship Award: Wound Healing Fellow Scholarship   Many healthcare professionals can boast about landing careers in which they have the opportunity to make significant impacts on the lives of their patients each and every day. Not quite as many can say they also do the same for the likes of their peers as well as medical and nursing students just as frequently. File Gosia Plummer among those of the second variety.   Plummer, an assistant professor of clinical surgery at the University of Illinois Hospital and Health Sciences System (UIHHS), Chicago, makes her presence felt not just through the direct care and oversight she provides at the bedside among patients living with difficult-to-heal wounds, but through the education and example she sets for UIC students, interns and residents (as well as those on staff at UIHHS and affiliated Advocate Christ Medical Center in Oak Lawn) under her wing — a population of aspiring and dedicated professionals who are afforded an education that that far exceeds the scope available to their very own instructor while she studied in her native Poland in the mid 1990s.   “I definitely did not have anything like this type of experience when I was in school; I didn’t get any wound care experience until my residency,” said Plummer, who earned her MD from Warsaw Medical University in 2001 before relocating to the US, graduating from the internal medicine residency at Christ Hospital in 2008. She then became the first physician to complete the UIHHS-based wound healing and tissue repair fellowship, a one-year clinical fellowship developed by the American College of Wound Healing and Tissue Repair, a non-profit organization located in Illinois.   The “experience” she refers to includes exposure to a complex patient population that sees many who live with advanced diabetes, transplant recipients, and other imunosuppressed patients experiencing slow-healing wounds.   “Our patients are more prone to infection, and their healing potential is decreased, so they really rely on us to initiate proper healing of their wounds,” Plummer said. “The advanced wound care that we perform is only really seen at a few major university centers throughout the country. Our team is more oriented to a holistic approach to healing.”   Among these patients is also a niche population of those from indigent groups of low economic status who have little access to healthcare and are often presenting later in the disease process and thus requiring higher levels of care. It’s a level of care rendered by a multidisciplinary team that collaborates to formulate care plans while on rounds as well as “behind the scenes.” Plummer said the exposure given to interns and students is quite similar to that of existing staff when appropriate.   “We offer fellows multiple advanced rotations with our surgical, infectious disease, and rehabilitation teams,” she said. “We treat the patients not from the point of the wound, per se, but collaboratively with other providers who are treating a wide range of comorbidities that are influencing the healing process of their wounds. It’s a very multi-specialty approach where we’re focusing just as much on their other healthcare complications as we are their wounds. This allows our students to get more hands-on experience of working in a multidisciplinary capacity and provide input to other unit staff.”   Most notably, Plummer highlights UIHHS’ and Christ’s aggressive limb-salvage program, which allows students to learn about risk factors and how to treat peripheral vascular disease. “We have specialized approaches to diabetic foot ulcers, orthopedics, and our paraplegic patients living with pressure ulcers that need flap coverage and plastic surgery,” she said.   “Our students are not only learning how to approach a patient’s wound, but how to work with a multispecialty team and arrange care while learning to collaborate professionally.”   In her clinical role, Plummer conducts assessments and establishes care plans at the bedside while providing follow-up care on inpatients and outpatients. As a consult for those patients living with nonhealing wounds, she assists residents who participate on her rounds and works in the outpatient clinic at Christ, a tertiary-level care center, where she also fosters student involvement. As a clinical instructor and lecturer at UIC, she teaches nursing students as well as medical students and residents from internal medicine and surgery. Her students study her interaction with patients, assess and examine them along with her, and discuss their conditions and what wound care modalities are available to produce optimal healing outcomes.   “I’m getting a lot of personal satisfaction out of the teaching I do,” said Plummer, who earned the SAWC’s Wound Healing Fellow Scholarship award this past March. “I’m helping students understand the consequences of a patient’s overall health on wound care. It’s always rewarding to see my students excel and be able to make the appropriate assessments and set up successful plans of care to help their patients. I’ve seen interns become senior residents who know how to approach their wound care patients and initiate their own plans for limb salvage. It’s really great to see.”   She said her students are also getting the opportunity to participate in additional innovative practices.   “Our team is very strong in implementing energy-based modalities like ultrasound and electrical stimulation in different phases of wound healing, and we’ve seen dramatic improvements in many of our patients and improved healing times. We work with artificial skin grafts, stem cell clinical trials, and irrigation solutions,” she said. In turn, Plummer plays a bit of a role as a student through her regular attendance at SAWC symposiums, which she said remains a great means to educate herself on her chosen field.   “Wound care patients are quite often undertreated, under-diagnosed, and the magnitude of the need for wound prevention is still unappreciated; so it’s always great to be around a lot of people at SAWC who think in similar terms as me,” she said. “The speakers and lectures are always excellent, and this scholarship is a testament to the work that we do as providers.” --Joe Darrah Destined for Wound Care: An unexpected patient leads one physical therapist to alter her career scope. Clinician: Jaimee Haan, PT, CWS, team leader, physical therapy wound management, rehabilitation services, Indiana University Health Scholarship Award: Wound Care Therapist Scholarship   It was almost as if by accident that Jaimee Haan entered the wound care arena more than 10 years ago. Today, she still looks back on the first encounter she had with her first wound patient as one of the most defining moments of her healthcare career. Working as a physical therapist in an extended care facility where she had quickly become accustomed to caring for treated patients who needed traditional PT to recover from hip replacement surgeries or strokes. One day she was asked to meet with a patient who had a nonhealing heel ulceration that had become infected and necrotic, requiring debridement and whirlpool therapy. The patient, Emma, even inspired Haan to give the same name to her daughter.   “I am almost embarrassed to say that I had no experience seeing wound patients, but I did what the doctor ordered,” said Haan, who today serves as the team leader for PT, wound management, and rehabilitation services at Indiana University Health. “The first time I picked up the scalpel, I fell in love. It amazed me how much progress I saw each day from the treatment I provided Emma. The progress this patient’s wound made and the impact I had on this patient’s life was so much more fulfilling for me than what I experienced with traditional physical therapy. I knew at that point I wanted to do wound care as a profession.”   So, she started job-hunting for a position that would allow her to conduct wound management full time. Now 13 years later, she’s still with Indiana Health on a team that has grown from two members (herself and Sharon Lucich, PT, CWS) to 18 therapists who care for in/out patients located in four hospitals that offer level 1 trauma services.   In her role, Haan is responsible for management of personnel (including physicians, PTs, PT assistants, and diabetic educators), program development, and managing the day-to-day workflow of patients within the in/outpatient wound programs. She also facilitates educational opportunities for family practice residents, physical therapy students, and healthcare staff. Though the time she spends involved in direct patient care has become more limited as she’s assumed more management responsibilities, she remains involved at the bedside by conducting consults and guiding therapists who make evaluations and construct care plans. Additionally, she plays a role in quality assurance by collaborating with medical directors to ensure best-practice protocols are devised and used.   “I feel as though my role as a team leader of therapists providing wound management has had a greater impact on more patients than actually providing hands-on, direct patient care,” said Haan, who has earned the SAWC Wound Care Therapist Scholarship.   That impact is also realized through her work as a co-chairperson for the wound care council for her regional VHA, a nationwide network of community-owned healthcare systems. She’s also secretary for a wound management special interest group in the clinical electrophysiology and wound management section of the American Physical Therapy Association and is a task force leader within the American Physical Therapy Association. One who’s working towards achieving wound management specialization through the American Board of Physical Therapist Specialists, Haan is also a member of the American Board of Wound Management and the Association for Advancement of Wound Care. As co-owner of Wound Ed, a company that provides education specific to wound management to PTs across the US, her reach extends that much further. I speak and present posters at wound conferences regionally and nationally.   “Most importantly, I advocate for the physical therapist’s role and involvement in the care of patients with wounds on a daily basis,” she said. “ I feel the physical therapist plays a vital role in the wound care continuum through our skills in debridement, addressing functional impairments, and treating the whole patient to lead to positive outcomes. Range of motion, gait training, and strengthening are often key to healing a wound and preventing reoccurrence. Physical therapists also have a unique skill in that we provide education to patients on their disease process, wound treatment plan, and wound prevention. We also have knowledge in the management of lymphedema, which, more often than not, is associated with patients with leg wounds.”   Through her work as a therapist, she’s confident that she’s helping more patients who live with chronic wounds lead more active and fulfilling lifestyles.   “Rehabilitation has improved significantly over the years,” she said. “We now are tasked with finding ways to heal wounds and still allow our patients to go on with their lives, as many work or attend school throughout the day. I anticipate we will continue to see more and more patients with wounds who do not have to remain bedridden. Hospital length of stay continues to decrease, which means patients are getting rehabilitated quicker and out of bed quicker. The advantage is less pressure ulcers related to being bedridden. The disadvantage is that the extrinsic factors are much harder to control when patients are outside of the hospital environment, such as blood sugar, weight-bearing, infection control, smoking, etc.”   By attending educational gatherings like SAWC, Haan is encouraged to network with her fellow providers to discuss effective care measures across the care continuum.   “SAWC is the best conference for professionals who practice in the area of wound management to receive the highest quality education with a variety of topics all in one conference,” she said. “This conference represents what wound management should be. SAWC has impacted my career by providing me with education and opportunities that have elevated my professional career. I have never walked away from SAWC where I haven’t learned something that I can incorporate into my practice the day I return to work.” --Joe Darrah