EdwardJamaluProductManagement
BELGIUM FEDERATION OF WOUND CAREOCTOBER 12TH 2010
IndonesiaatAGlance
IndonesiaatAGlance
Islands :17.508islandsWideRange :1.904.569kmsqPopulation :237.556.363person
(More50%inJava)Density :124person/kmsqGDPAverage :$3,979/yr
3,000
3,200
3,400
3,600
3,800
4,000
4,200
4,400
1 2 3
MARKETSITUATIONONIPAIHPA(NONIDA):VALUETRENDOFFIRSTLINEWOUNDCARE
2008 2009 2010
Gr. 10.30%
Gr. 8.28%
IPA IHPA = Indonesian Pharmaceutical Audit Indonesian Hospital Pharmaceutical audit. IDA = Indonesian Drugstore Audit. (/1000)
MAT Q2
MARKETSITUATION(VALUE):BASEDONIPAIHPAMATQ22010(NONIDA)
VALUE MS % GR % VALUE MS % GR % VALUE MS % GR % VALUE
1 SELECTED TOTAL 1,172,755 100.00 11.90 4,197,567 100.00 10.30 3,805,600 100.00 8.28 3,514,590 1 BETADINE MKB 536,080 45.71 15.85 1,795,288 42.77 2.65 1,748,866 45.96 20.39 1,452,642 2 DARYANT-TULLE D.V 125,365 10.69 29.94 441,121 10.51 -2.09 450,557 11.84 60.62 280,516 3 BIOPLACENTON KLB 124,431 10.61 -2.98 499,273 11.89 0.10 498,767 13.11 32.11 377,551 4 SOFRA-TULLE S.A 101,141 8.62 56.57 318,090 7.58 119.90 144,650 3.80 -63.79 399,460 5 MEBO COM 89,743 7.65 55.75 324,295 7.73 39.05 233,219 6.13 134.58 99,421 6 BURNAZIN D.V 64,742 5.52 -32.47 247,232 5.89 15.43 214,190 5.63 93.94 110,442 7 MADECASSOL CRA 54,926 4.68 -1.00 228,947 5.45 -9.16 252,024 6.62 -6.67 270,049 8 ISODINE MKB 26,180 2.23 -43.36 146,005 3.48 1.35 144,061 3.79 -45.22 262,977 9 SANOSKIN OXY IBT 16,448 1.40 160.91 54,240 1.29 732.92 6,512 0.17 999.00 -
10 CERPLAST G2P 11,852 1.01 5.90 61,900 1.47 78.58 34,663 0.91 581.67 5,085 11 SANOSKIN M.DERM + IBT 8,375 0.71 34.55 29,030 0.69 358.96 6,325 0.17 999.00 - 12 DERMAZIN LEK 6,680 0.57 -41.07 29,084 0.69 -36.23 45,610 1.20 -69.27 148,423 13 BETADINE FOR KIDS MKB 3,414 0.29 57.02 10,777 0.26 -11.07 12,119 0.32 -18.77 14,919 14 SOLCOSERYL SLC 3,378 0.29 -4.62 12,285 0.29 -12.48 14,037 0.37 -84.92 93,106
MAT Q2 09 MAT Q2 08RANK Q2 10 PROD DESC
Q2 10 MAT Q2 10
MAT = Moving Annual TrendMS = Market Share, GR = Growth Value vs Value Last Year
Classification
AcutewoundChronicwound
ChronicWoundChronicwoundisdefinedasabreakinthe skinoflongduration,morethan6weeksorfrequentrecurrenceTrappedinanongoinginflammatoryphase
FowlerE.Chronicwounds:anoverview.In:KrasnerD,editor.Chronicwoundcare:aclinicalsourcebookforhealthcareprofessionals.KingofPrussia,PA:HealthManagementPublications,Inc;1990.pp.128.
ChronicwoundCommoncause
VenousstasisDiabetesmellitusPressurenecrosisIschemia
OthercauseMalignancyVasculitisPyodermagangrenosum
Assessment&WoundCareJakarta(CiptoMangunkusumoNationalGeneralHospitalisAnIdealModel)
VascularSurgeonmakingassessmentofwoundandconsulttoEndocrinologist(Diabeticpatient),Orthopedicifneedamputation,PlasticSurgeon(SkinGraftandflap),NeurologistorPediatric(asaTeam)andnursestakeoverwoundcareofpatientsupervisedbyVascularSurgeon
BigCities(Surabaya,Medan,Bandung,Makassar,Manadoetc)AssessmentisdonebySpecialist/GPERwhoiscaringpatientandsometimeconsulttoPlasticorvascularsurgeon(asateam)butnursestakeoverwoundcareofpatientsupervisedbythedoctor
SmallCities/VillageWoundcareisdonebyGPERandNursesoronlynurses
NursingEducationStartfrom18yo(afterHighSchool)andtake3years(Academy)Method:Theorylessonandpractical/handsonstartfrom1st year90%femalenursesand10%malenursesHaveNurseOrganization/UnionHaveASpecialOrganizationfornursesthatworkatSurgeonRoom(HIPKABI),undersupervisedbyIndonesianSurgeonAssociation(PABI)HIPKABIgavethemTraining&WorkshopaboutWoundcare,continuously.
Management
Management of UlcersWound Care
DebridementWound cleansingDressings ( Moist)Adjuvant therapies
Pressure reductionOr it will not heal
Risk factors addressedContinence careNutritional improvementMobility
Consider operative repair
BasicsOptimizesystemicparametersDebridenonviabletissueReducewoundbioburdenOptimizebloodflowReduceedemaUsedressingsappropriatelyUsepharmacologictherapyClosewoundswithgrafts/flapsasindicated
OptimizesystemicparametersAge:cannotbereversed,usageofgrowthfactors,aggressiveoptimizationofsystemicparameters&supplementation.Avoidanceofischemia&malnutrition.CorrectionofdiabetesAvoidanceofsteroids,alcohol,smoking.Avoidanceofreperfusioninjury:totalcontactcasting,compressiontherapy.
Debridement&ReductionofBioburden
Surfaceirrigationwithsaline.Debridement:surgical,enzymatic(papainwithurea,collagenase),mechanical(pressurizedwaterjet),autolytic,maggots.Antibiotics:cellulitis,decreasedrateofhealing,increasedpain,strawcoloredoozingfromskin,contaminatedwounds,mechanicalimplants.RemovalofFB.
RecentDevelopmentsHoneyProductinlegulcers.Hydrogelindeep2nd degburns.LASERtherapyenhancestissuerepair?Nitricoxidecontainingnanoparticles
FocusonDiabeticWound
DiabetesinIndonesiaWHO:2007:Indonesiais4th RankintheworldofDiabeticPatient(AfterUSA,IndiaandChina)2000:8.4MillionDiabeticpatient2007:11MillionDiabeticpatient2030:22MillionDiabeticpatient(11%ofpopulation)
CoMorbidityinDiabetes
Peripheralvasculardiseaseoccursin11%ofdiabeticpatientsPeripheralneuropathyoccursin42%ofdiabeticpatientsPVDisassociatedwithdelayedulcerhealingandincreasedratesofamputation
TreatmentofDU:WhatWorks
Mustsurgicallydebrideulcertoallowhealing:thewoundedgesaredeadWeeklydebridementdowntohealthybleedingtissuegivesbestresultsMustkeeppressureofftheulcerstoallowhealing
PressureReductionOffDUOrthopedicshoes:droprecurrenceratefrom83%to17%SandalsSplintsCrutches/wheelchairsTotalcontactcasting
DiabeticGangren
HoneyBaseProductForWoundCare
ReceivedUSFederalDrugAdministrationapprovalin2007AntiinflammatoryandAntibacterialeffectswithoutantibioticresistancePromotemoistwoundhealingLowpHFacilitatedebridement
TherapeuticEffectsofHoneyDressings
2Antimicrobial31Anti-inflammatory Debridement
4ReducesMalodour5Promoteshealing
6Scarlesshealing
PieperB,JWoundOstomyContinenceNurs2009;36(1):606
Female,56thBloodpressure:!40/100ABIRight:1Left:0.6Albumin:2.8
PreopIGD27.3.2010
PostDebriIGD30.3.2010 PostRedebriIBP16.4.2010
PostReDebriIBP2.5.2010PostSTGS6.5.2010
FemaleBloodpressure:120/80
ABIRight:1.08Left:1.08
Albumin:3.0
PreOp,March10th
PostDebridement,March13th PostSTSG,March21th
FemaleBloodpressure:150/80
ABIRight:0.91Left:1.0
PreOp,March10th
PostOpMarch18th PostSTSGApril15th
Male50yo
Bloodpressure:Normal
FirstCome
After2weeksWoundCare After4weeksWoundCare
Summary
WoundCareManagementisgoodenoughbutHealthserviceandhumanresourcesmustbeimprovedTheriskfactorsmustbeevaluatedbythedoctorespeciallyindiabetespatientModernwoundcare productsarebeingusedmoreandmoreinmodernwoundcare (Sanoskin)
BunakenSeaPark,Manado,NorthSulawesi,Indonesia
