GLOSSARY OF TECHNICAL TERMS

The selected terms in this glossary are defined within the context of predicting, preventing and successfully treating chronic and non-healing wounds and bedsores (aka Pressure Ulcers or Decubitus Ulcers) non-surgically.

A

Advanced Pressure Reducing See Pressure Relieving and Support Surfaces.

Agency for Health Care Policy and Research (AHCPR) is now Agency for Health Care Research and Quality (AHCRQ). See below.

Agency for Health Care Research and Quality (AHCRQ) formerly Agency for Health Care Policy and Research (AHCPR) sponsors research in the area of health care by interdisciplinary, non-Federal panels of health care professional and consumers. AHCPR is sponsored by and affiliated with the U.S. Department of Health and Human Services, Public Health Services. AHCPR was established in December 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of 1989) to enhance the quality, appropriateness, and effectiveness of health care services and access to the services. AHCPR carries out its mission by conducting and supporting general health services research, including medical effectiveness research, facilitating development of "Clinical Practice Guidelines," and disseminating research findings and guideline research findings to health care providers, policymakers, and the public.

Aggregate A mass or assemblage.

AHCPR See Agency for Health Care Research and Quality (AHCRQ).

AHCRQ See Agency for Health Care Research and Quality (AHCRQ), formerly Agency for Health Care Policy and Research (AHCPR).

Alginate A salt of alginic acid, which is extracted from marine kelp. Calcium, sodium, and ammonium alginates have been used as foam, clot, or gauze for absorbable surgical dressings.

Amino Acid Any organic compound containing an amino and a carboxyl group.

Angiogenesis⁵ /an'je-ojen'sis/ 1) The process by which new blood vessels are formed.
2) The ability to grow blood vessels.

Autolysis⁵ (ô tol'uh sis) n. The breakdown of ... animal tissue by the action of enzymes contained in the tissue affected; self-digestion. ol-y-sis (ô tol'uh sis) n.

B

Bedsore⁵ (aka pressure ulcer or sore, decubitus ulcer). An ulceration of tissue deprived of adequate blood supply by prolonged pressure. See Pressure Ulcer, Staging Pressure Ulcers, Decubitus Ulcer and Decubitus Care.

C

Chemotactic Factor Orientation of a cell along a chemical concentration gradient or movement in the direction of the gradient.

Chronic⁵ or Chronic Illness ... /kron'ik/ 1) referring to a disease or disorder that develops slowly and persists for a long period of time. It can sometimes remain for the person's lifetime.
2)⁶ marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness ... having a slow progressive of indefinite duration - used especially in degenerative invasive diseases, some infections.
3)¹³ In chronic wounds (includes bedsore, decubitus ulcers and pressure ulcers and sores) it is usually understood to define a wound that has not healed in thirty (30) days. Diabetic patients normally sixty (60) days before the wound is declared chronic or non-healing.
4) An illness of long-term or permanent nature that may be accompanied by some residual disability resulting in the need for rehabilitation or continuous care.

Chronic Obstructive Pulmonary Disease (COPD) See Pulmonary Disease.

Chronic wounds Wounds that take longer than normal to heal or do not heal at all because of underlying conditions.

Class I/II/III Support Surfaces / Specialty Beds Replaces the older hybrid term Group/Level and Level when referring to Support Surfaces / Specialty Beds. See Support Surfaces and Pressure Relieving.

Clinical Fact Sheet Developed by Medical Resources Group Inc. between 1995 and 1997. Based on original research, field clinical trials, longitudinal studies, patient case review and literature review of peer level medical and legal publications dealing with chronic non-healing wounds and pressure ulcers (aka bedsores, pressure sores and decubitus ulcers). All the Clinical Fact Sheets have been subjected to extensive outside peer review - medical and legal.

Clinical Practice Guideline(s)^1,2,3,4 developed to "enhance the quality, appropriateness, and effectiveness of health care services and access to the services. AHCPR (Now the Agency for Health Care Research and Quality, AHCRQ) carries out its mission by conducting and supporting general health services research, including medical effectiveness research, facilitating development of "Clinical Practice Guidelines" (AHCPR Guideline publications are available on this site) (emphasis ours), and disseminating research findings and guideline research findings to health care providers, policymakers, and the public. See Agency for Health Care Research and Quality (AHCRQ).

Collagen⁵ /kol'jn/ 1) The most prevalent protein in the animal kingdom responsible for the structure and integrity of most tissues. A protein containing domains of triple-helical conformation. Characterized by repetitive Gly-X-Y sequences where glycine is in every third residue, and stabilized by proline and hydroxyproline residues. A protein that participates in formation of extracellular aggregates which are primarily supporting elements.
2) The protein substance of the white fibers of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen.
3)a protein consisting of bundles of tiny fibers... is the most abundant protein found in the body. It is safe enough to be used as a food product and versatile enough to handle problems ranging from fluid absorption to regeneration of tissue. Collagen fibers give strength and structure to tissue in the body. Fibroblast cells produce collagen, which forms tissue structures. Tissues contain collagen fibers arranged in three dimensions. Collagen fibers contain smaller units called fibrils. Fibrils are organized collagen molecules. Each molecule is a rope-like structure with three strands. Each strand has a specific sequence determining collagen type and function. For collagen to effectively work in chronic wound healing it must be fully functional, self-assembling, and specific to skin tissue.⁷ See Kollagen™.

For more details about collagen's role in wound healing, See:

1. How the Wound Healing Process Works
2. Collagen's role in healing skin tissue." New World Health 1995
3. "Collagen's Role in the Wound Healing Process." BioCore Medical Technologies, 1996
4. Or read "Wound Healing: Biochemical & Clinical Aspects," 1992 by Cohen, Diegelmann, Lindbald et al. available from the National Institute of Health.

Collagenase 1) any of a group of proteolytic enzymes that decompose collagen and gelatin.
2) An enzyme that catalyzes the hydrolysis of peptide bonds in triple helical regions of collagen.

Collagenase ointment a drug used to treat bedsores, burns, and other skin disorders.
 

Note: Collagenase ointment in any form destroys collagen.

Collagen Fibrils Delicate fibrils of collagen in connective tissue, usually cemented together in wavy bundles.

Common Procedure Coding System (HCPCS) The HCPCS Code is used to identify items of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for purposes of Medicare billing. The SADMERC, acting for HCFA and the four DMERCs is the sole authority on HCPCS Codes. The information on medical equipment and supplies developed for HCFA by its SADMERC, administered by the four DMERCS is the benchmark for Medicare and has become the de facto benchmark for the large majority of third party -insurance companies- payors.

COPD See Pulmonary Disease.

Cost Benefits Measured by assessing a treatment's ability to heal and prevent recurrence, the time it takes to heal and the frequency of dressing change it requires.

Cost Effectiveness The cost of achieving a desired outcome of treatment.

D

Decubitus Ulcer^{5 (1,2,3)} (aka bedsore, pressure ulcer or sore) A swollen sore or ulcer of the skin over a bony part of the body, results from prolonged pressure on the part. Decubitus Ulcers are most often seen in patients not able to move around easily, as the elderly, infirm, or severely ill. The sores are graded by stages of severity: Stage I: The skin is red and does not return to normal with relief of pressure. Stage II: The skin is blistered, peeling, or cracked, though damage is still minor. Stage III: The skin is broken and tissue under the skin may also be damaged, and drainage may be seen. Stage IV: A deep, craterlike ulcer has formed. The full thickness of skin and the underlying tissues are destroyed. Prevention of Decubitus Ulcers is an essential aspect of care. See Pressure Ulcer, Staging Pressure Ulcers and Bedsore.

Decubitus Care^{5 (1,2,3)} preventing and treating sores that form over bony parts of the body (decubitus ulcers, aka pressure ulcer or sore, bedsore). They occur in patients not able to move around, especially the elderly, the obese, and the seriously ill. These ulcers occur on pressure areas, most often on the bottom of the spine, elbows, heels, outer ankles, inner knees, hips, shoulder blades, and ear rims.
METHOD: Decubiti may be prevented by turning the patient every 2 hours (or alternatively placing the patient on a Class II Support Surface / Specialty Bed to relieve the pressure 24 hours per day, comment by WoundHEAL), keeping the skin dry, and watching pressure areas for signs of redness. Care for decubitus ulcers, which can take a long time to heal, involves cleaning the area and applying special drugs to the ulcers. Large areas of ulcers can be life-threatening. Prompt and continued care of early ulcers can prevent infection and promote healing. See Pressure Ulcers, Staging Pressure Ulcers, Support Surfaces, Pressure Relieving.

Deep Cavity Wound A hollow place or space within the body or in one of its organs situated far beneath the surface, not superficial.

Diabetes Mellitus A disorder of carbohydrate metabolism, characterized by hyper-glycemia and glycosuria and resulting from inadequate production or utilization of insulin.

DMERC See Durable Medical Equipment Regional Carriers.

Drainage/Draining The free flow or withdrawal of fluids and 6 scharges from a wound, sore, or cavity.

Dressing A covering, protec-rise or supportive, for all diseased or injures parts. Edema: A local or generalized condition in which the body tin-sans contain an encesuive arrount of tissue fluid Erythema: A rame applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes.

DRY FLOATATION^®* describes a unique mattress system designed and invented by the founder of ROHO^® Inc. It is a dry fluid air system that combines that best properties of both an air and liquid medium without the use of any liquid to equalize and relieve pressure over the body's bony prominences. It delivers compression therapy to the whole body when used in the mattress system configuration. The ROHO^® DRY FLOATATION^® Mattress System is certified as a Class (Group/Level) II Support Surface / Specialty Bed. See Support Surfaces / Specialty Beds and Pressure Relieving.

*ROHO^® and DRY FLOATATION^® are registered trademarks of ROHO^® Inc.

Related Articles

1. Informed Consumer: Support Surfaces & Specialty Beds Class I - II - III
2. Low Cost Provider Survey located in our Products section.

Durable Medical Equipment Regional Carriers (DMERCs) HCFA has established four Durable Medical Equipment Regional Carriers (DMERCs) to act on its behalf in the administration of Medicare claims. The respective DMERCs are known as fiscal intermediaries ... acting under contract for HCFA. The information on medical equipment and supplies developed for HCFA by the SADMERC, administered by the four DMERCS has become the de facto benchmark for the large majority of third party -insurance companies- payors.

E

Edema The presence of an abnormally large amount of fluid in the intercellular tissue spaces.

Epithelialization Healing by the growth of epithelium over a denuded surface.

Epithelium The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities.

Existing Medical Necessity or Medical Necessity^4,8,9,11 are terms used by medical services providers to assert that the services, supplies and equipment provided for the treatment of a patient's existing medical condition(s) meet the minimum standard (patient's medical condition) set forth by the third party insurer (inclusive of Medicare*) for there respective use. In the case of pressure ulcers (bedsores), there are two distinctly separate applications of the minimum standards: One, for acute care (hospital) treatment environments. And the second, substantially more restrictive standard for patients in their own residence.

Related Articles

1. Existing Medical Necessity document located in our Healing section.
    
2. Minimum Standards of Care for Patients with Pressure Ulcers detailed in DHHS' AHCPR "Pressure Ulcer Treatment: Clinical Practice Guideline."
   To find out more about AHCRQ (formerly AHCPR you can go to their Web site at http://www.ahcrq.gov.

Exudate Accumulation of a fluid in a cavity, or matter that penetrates through vessel walls to adjoining tissue, or the production of pus or serum

F

Fibroblasts A connective tissue cell. They differentiate into chondroblasts, collagenoblasts, and osteoblasts, form the fibrous tissues in the body, tendons, and aponeuroses, supporting and binding tissues of all sorts.

Fibronectin An adhesive glycoprotein. Fibronectins are important in connective tissue, where they cross-link to collagen, and they are also involved in aggregation of platelets.

G

Granulation The process of forming granulation tissue.

Granulation Tissue Small, beadlike masses of tissue formed on the surface of wounds.

Group/Level is a classification term used to identify Support Surfaces/ Specialty Beds by their respective therapeutic performance value with Group/Level I being the lowest classification. It is a hybrid term that is gradually being replaced with the term Classification I / II / III. See Support Surfaces and Pressure Relieving.

H

HCPCS Code See Common Procedure Coding System.

Hemostasis The arrest of bleeding, either by the physiological properties of vasoconstriction and coagulation or by surgical means.

Hydrogel A gel that has water as its dispersion medium.

I

Infection The state or condition in which the body or a part of it is invaded by a pathogenic agent that, under favorable conditions, multiplies and produces injurious effects.

Inflammation A localized pro-tective response elicited by injury or destruction of tissues which serves to destroy, dilute, or well off both the injurious agent and the injured tissue.

J

K

Keratinocytes The epidermal cells which synthesizes keratin; constitutes 95 percent of the epidermal cells and with melanocyte, forms the binary cell system of the epidermis.

Kollagen^TM* is BioCore's Medical Technologies trade name for its collagen based wound management materials: Medifil^TM Particles, Gel and SkinTemp^TM. The collagen contained in all BioCore products is specific to the skin tissue, FDA certified. See Collagen.

*Registered trademark of BioCore Medical Technologies Inc.

L

Leukocytes White blood cor-puscles which sct as scavengers, helping to combat infection.

Level I/II/III Support Surfaces / Specialty Beds See Support Surfaces and Group/Level.

Liability The quality or state of being legally obligated.

M

Maceration⁵ the softening and breaking down of the skin from prolonged exposure to moisture.

Macrophages Any of the many mononuclear phagocytes found in tissues.

Medical Necessity or Existing Medical Necessity^4,8,9,11 are terms used by medical services providers to assert that the services, supplies and equipment provided for the treatment of a patient's existing medical condition(s) meet the minimum standard (patient's medical condition) set forth by the third party insurer (inclusive of Medicare*) for there respective use. In the case of pressure ulcers (bedsores), there are two distinctly separate applications of the minimum standards: One, for acute care (hospital) treatment environments. And the second, substantially more restrictive standard for patients in their own residence.

Related Articles

1. Existing Medical Necessity document located in our Healing section.
    
2. Minimum Standard of Care for pressure ulcers detailed in DHHS' AHCPR "Pressure Ulcer Treatment: Clinical Practice Guideline."
   To find out more about AHCRQ (formerly AHCPR you can go to their Web site at http://www.ahcrq.gov.

Minimum Standards of Care (Professional Standards of Quality, Quality of Care, etc.) See Standards of Care.

Moist Wound Healing To maintain a moist environment at the wound bed so as to enhance epidermal cell migration and encourage epithelialization.

Monocytes A mononuclear phagocytic leukocyte. Formed in the bone marrow from promonocytes, monocytes are transported to tissues, as of the lungs and liver, where they develop into macrophages.

N

National Pressure Ulcer Advisory Panel (NPUAP) The nationally recognized authority on pressure ulcer (aka bedsore, decubitus ulcer) was formed in 1987 to provide a credible panel of experts to raise awareness and provide information on pressure ulcers, the group began working in the areas of public policy, education and research. NPUAP, now assisted by multiple corporations and organizations, has become a nationally recognized entity. The collaboration of professionals, corporations, and governmental agencies offers a unique model for addressing major health care issues. The European Pressure Ulcer Advisory Panel and the Japanese Society of Pressure Ulcers have adapted the NPUAP model in establishing their organizations.

Legislatively, the NPUAP was instrumental in amending the Omnibus Budget Reconciliation Act of 1987 (Nursing Home Reform Act) in order to strengthen the bill's language that related to quality of care for patients in long term care facilities. In 1989 the NPUAP was recognized by the National Academy of Science.

The legislative credibility of the NPUAP is further documented by the invitation in 1990 to four of its members to serve on the Agency for Health Care Policy Research (AHCPR) (emphasis ours) panel for the development of guidelines for the Prediction, Prevention and Early Treatment of Pressure Ulcers in Adults, released in May, 1992. This panel of 13 was responsible for the creation of guidelines which also greatly influence the health care profession and the quality of care for patients in the acute, home and long term care settings. Seven members of the NPUAP were also invited to serve on the second AHCPR Pressure Ulcer Panel formed to create guidelines on the treatment of pressure ulcers. This guideline was released in December, 1994. See below.

Related Articles

1. Visit the AHCPR (AHCRQ) Clinical Practice Guidelines and the
2. "Minimum Standards of Care for Support Surfaces for Patients with Pressure Ulcers," 01/97. Published by Medical Resources Group Inc.

Necrosis The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes.

Necrotic Tissue Celi dears causes by the progressive degradative action of enzymes.

Negligence The doing of some act which a person of ordinary prudence would not have done under similar circumstances or the failure to do what a person of ordinary prudence would have done under similar circumstances.

Neovascularization New blood vessel formation in abnormal tissue or in abnormal positions.

Neutrophils Granular leukocytes that have a nucleus with three so five lobes. They have the properties of chemotaxis, adherence to immune complexes, and phegocytosis.

NPUAP See National Pressure Ulcer Advisory Panel.

O

Occlusive Dressing A dressing that seals a wound completely to prevent infection from without and to prevent moisture from within from escaping through the dressing.

Osteomyelitis⁵ /os'te-omi-li'tis/ an infection of bone and bone marrow. It is most often caused by a bacterial infection, germs that enter the bone during an injury or surgery. The germs may also reach the bone directly from a nearby infection or through the bloodstream. Staphylococci germs are often part of the cause of this problem. The long bones in children and the spinal bones in adults are often places of infection caused by germs spreading through the bloodstream. Continuing and increasing bone pain, tenderness, local muscle spasm, and fever are symptoms of the disease. Treatment includes bed rest and anti infection drugs by injection for several weeks. Surgery may be necessary to take out dead bone and tissue, to fill holes, and to use artificial devices to keep the diseased bones and joints from moving. Long-term osteomyelitis may go on for years with periods of many or fewer symptoms in spite of treatment

Outcome-Based Wound Healing Therapy that heals the wound faster, cheaper, and better than other therapies.

Outco