In order to ensure that our project is relevant and applicable in the real world, we have been talking to many experts from academia and the clinic as well as people with personal experiences. In addition to that we've been doing background research through literature to understand the extent of the problem and its impact on the world.
We had three main ideas. One was antibody production in yeast and a second was producing energy in bacteria. Our third idea was more vague but it revolved around biofilms. On one hand we were thinking about combating biofilms on medical devices and on the other, the biofilms in wounds.
Below, we have documented the steps we took during our project to evaluate the impact of our solution and how we've adjusted it based on the discussions we've had and the research we've done.
Why should we treat chronic wounds?
Chronic wounds include diabetic foot ulcers, venous leg ulcers and pressure ulcers (Frykberg, 2015). Between 15 % to 25 % of diabetes patients, for instance, develop diabetic foot ulcers (Huang and Kyriakides, 2020). Patients that suffer from diabetic foot ulcers are observed to have a higher morbidity and mortality than both healthy patients and other diabetics with a better-managed condition (Moulik et al., 2003). They have a decreased quality of life and higher amputation rates, as explained to us by local dermatologists, plastic surgeons and wound care nurses at the Helsinki University Central Hospital.
Chronic wounds do not only cause a decrease in the quality of life for the patients themselves, but also for the people around them due to the time and energy spent on caretaking. It has been estimated that in developed countries, 1-3 % of total healthcare costs go towards chronic wound management (Järbrink et al., 2017). Within the EU, up to 50% of the hospital beds are occupied by patients with wounds (Posnett et al., 2009). Though the wounds are a mixture of acute and chronic injuries, the latter take up greater resources due to the many in- and out-patient follow-ups over time consuming both human resources and treatment materials. Those numbers do not describe only the expense to the governments, but also the opportunity cost that could have been used for example in research, treating other patients, development and humanitarian work.
The daily pain of chronic wounds already decreases their sufferers' quality of life, alongside the inconvenience of limiting the movements and resting positions that can be taken. 90 % of chronic wounds have bacteria commonly settling at the wound site and are not easily cleared by the immune system (Attinger and Wolcott, 2012). These bacteria then keep building up into thicker biofilms (a structural community of bacteria), which can cause further issues as they are known to be tolerant to antibiotics and host defences (Høiby et al., 2010).
Since 2020, we have noticed how well-responsive the whole scientific community is when facing an epidemic or pandemic: it comes together in solidarity to work on a solution. But there are other epidemics plaguing the healthcare system - and people's quality of life - that remain silent and that equally deserve such a swift, collaborative reaction. Our team wants, therefore, to bring visibility and a viable solution to one such silent epidemic, chronic wounds (Lindholm and Searle, 2016).
(Figure created with BioRender)
The clinicians shed a much better light on the patient side, too, especially the treatment adherence difficulties experienced. For example, patients do not tend to continue regularly applying treatment to their wounds as prescribed once they become outpatients, highlighting the need for a very simple, straightforward and effective solution to prevent biofilm formation. The clinicians agreed for us to interview patients, and advised us to get official approval for this from the Ethics Committee. Even though we weren't able to interview patients in the end, we got good advice on the consent form and patient interview questions from them.
After the meeting and to guide our collaboration with Dresden, we continued to look into the different administration methods of our treatment, like creams and bandages that release therapeutic molecules into wounds, to make it as easy and convenient as possible for ambulatory patients to use. We also found a lot more information on public health costs associated with chronic wounds, as suggested to us by surgeon Heli Lagus.
(The Science Basement)
(The Science Basement)
Our initial plan was to interview patients from the wound clinic, but unfortunately because of limitations we weren't able to contact any patients in the timeframe we had. Instead we decided to look for patient experiences from people we know.
We collected three stories from our team members, that have or had a relative suffering from a chronic wound. The stories are described below:
"My grandmother's struggles began with a minor wound in a toe that was caused by a nail technician cutting a bit of the skin next to a toenail. When you recall the story after years have passed, it seems ironic that trying to take care of yourself as a diabetic patient led to the reason she lost her leg and eventually her life.
As is being said, everything started with a minor wound, however for diabetic patient's even minor wounds are important to be properly taken care of. How the wound was treated was just like from the text books; regularly cleaned and covered with wound dressings. Unfortunately, the wound just got more infected and no antibiotics helped. My grandmother was taken to a hospital when we noticed her toe had started turning black, meaning that her toe was undergoing gangrene, a tissue death caused by the lack of blood supply. Diabetes patients' are well known to have poor circulation in limbs.
Doctors decided that the only option is amputation at the middle of lower limbs, hoping that the circulation would be better and the amputation wound would heal properly. This was a major setback in my grandmother's life, however there was still hope that she could live on her own with little additional help. After the surgery, the healing process prolonged until she once again had a chronic wound that would not close or be uninfected. The blood circulation was not just enough. At this point, our family really started to feel the pain of our grandmother's fate. She was a lively person who enjoyed cultural events and visiting family members. That person seemed to fade away slowly.
The only option was to amputate the leg even higher, this time over the knee. It was clear that she would never be able to return home and would spend the rest of her life in elderly house or hospital. After the second amputation, it felt like the person in the hospital bed was not anymore my grandmother, the crippling depression had taken over her completely. Even after the second amputation the new wound would not heal. At this point, my grandmother's wish was to leave without pain. All the medications were stopped and she passed away the next day.
The process took almost two years. I can only imagine how my grandmother had felt during that time, but it was hard for the relatives as well. You never want to see them suffer. It truly showed me how small things can really turn into a worst nightmare, and how limited the options are for chronic wound patients.”
- “My great-aunt has been in and out of hospitals for quite some time now with different health problems. Among these, she has diabetes. Few months back, her toe had to be amputated because of a chronic wound that decreased her quality of life.”
- “My maternal grandmother's side of the family is prone to diabetes, and quite a few of her relatives have been at least pre-diabetic with elevated blood sugar, causing them to severely restrict their diet. The worst case was her older brother, my great-uncle. He had been living with type diabetes for over a decade, perhaps even close to two decades, injecting insulin into his abdomen around every meal time. His disease and his sedentary lifestyle in old age also cause bad circulation problems in his lower limbs, eventually leading to tissue necrosis in several toes. These toes had to be amputated, and he died shortly after, a few years back. It was very difficult for his wife to care for him all those years, and for my grandmother to see her brother deteriorating and get increasingly weak.”
These stories emphasised the importance of our project and proves that our solution is needed and provides a positive impact on the world. We hope to improve the quality of life for patients who suffer from chronic wounds. As the issue is so complex, our solution would likely be one part of the entire treatment process. These personal experiences and stories we heard were a big reason why the work we were doing felt so important to us. To better the quality of life or even to save a life is a huge reason to try to find an effective treatment. To realise so many encounters with these wounds in their lifetime motivated us to find a solution.
We have measured the impact of our project with our Integrated Human Practices through thorough literacy research, the feedback of professionals and the stories from patients themselves. We have concluded that our project does have a positive impact on the world. Additionally, the discussions we' ve had have impacted and steered our project development through the whole process. We have listened to the feedback we have gotten and tried to change our project for the better.
We have measured the impact of our project through thorough literacy research, the feedback of professionals and the stories from patients themselves. We have concluded that our project does have a positive impact on the world. Additionally, the discussions we've had have impacted and steered our project development through the whole process. We have listened to the feedback we have gotten and tried to change our project for the better.
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Yhteistyö haavanhoidossa: mahdollisuus parantaa laatua ja vähentää kustannuksiaDuodecim 2020;136:1702-4
Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by EtiologyDiabetes Care, 26(2), pp.491-494
The Resource Impact of Wounds on Health-care Providers in EuropeJ. Wound Care, vol.18 (4)
Interference in bacterial quorum sensing: a biopharmaceutical perspectiveFrontiers in pharmacology 9: 203