David H Keast

David H Keast
Lawson Health Research Institute · Parkwood Institute Research

BSc, MSc, DipEd, MD

About

62
Publications
35,194
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2,611
Citations
Citations since 2016
10 Research Items
1022 Citations
2016201720182019202020212022050100150
2016201720182019202020212022050100150
2016201720182019202020212022050100150
2016201720182019202020212022050100150
Introduction

Publications

Publications (62)
Article
Introduction: Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting...
Article
Full-text available
Objective Approximately between 1.5 and 3.0 per 1000 people are affected by venous leg ulcers (VLUs). The treatment and management of VLUs is costly and recurrence is a major concern. There is evidence that compression stockings can reduce the rate of re-ulceration compared with no compression. We present the first cost-effective analysis of compre...
Article
Full-text available
Background: Chronic edema/lymphedema is defined as edema present for more than 3 months. It is underrecognized and undertreated. The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema in heterogeneous populations. Cana...
Article
Background: Pressure injuries (PIs) represent a frequent, often preventable, secondary complication of spinal cord injury (SCI) with serious consequences to health, societal participation, and quality of life. Specialized knowledge and service delivery related to treatment and prevention are typically located within major health centers. Introducti...
Article
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On 9 May 2018, the authors took part in a closed panel discussion on the impact of cell salvage in acute and chronic wounds. The goal was to deliberate the possible use of plurogel micelle matrix (PMM) as a new treatment strategy for wound healing and the authors openly shared their experiences, thoughts, experimental data and early clinical result...
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Objective The objective of this study was to characterize factors associated with closure of venous leg ulcers (VLUs) in a pooled analysis of subjects from three randomized clinical trials. Methods Closure of VLUs after treatment with HP802-247, an allogeneic living cell therapy consisting of growth-arrested human keratinocytes and fibroblasts, vs...
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This evaluation involves an innovative muscle pump-activating device (geko™) as an adjunctive therapy with best practices for non-healing venous leg ulcers (VLUs). Stimulating the common peroneal nerve (at the fibular head), the geko™ device creates a response that acts as foot and calf muscle pumps, increasing venous, arterial and microcirculatory...
Article
In 2012 we reported promising results from a Phase 2 clinical trial of HP802-247, a novel spray-applied investigational treatment for chronic venous leg ulcers (VLU) consisting of human, allogeneic fibroblasts and keratinocytes. We now describe Phase 3 clinical testing of HP802-247, its failure to detect efficacy, and subsequent investigation into...
Article
Objective: Lymphoedema is estimated to affect up to 300,000 Canadians but remains underrecognised and undertreated. A retrospective chart review was conducted to determine the clinical characteristics and treatment practices of lymphoedema in a Canadian wound care clinic. Method: Data were collected retrospectively from dictated clinic notes of 32...
Article
Anemia of chronic disease (ACD) is thought to impair the responsiveness of erythroid progenitor cells, but research has shown treatment with recombinant human erythropoietin (rhuEPO) can improve patient hemoglobin levels and, subsequently, overall patient health status and quality of life. A prospective pilot study was designed to estimate the prev...
Article
Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design...
Article
Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. To define a patient-centred Canadian treatment strategy for onychomycosis. An expert panel...
Article
Even though it is estimated that at least 300 000 people in Canada may be affected by chronic oedema/lymphoedema, recognition of the seriousness of this chronic disease in health care is scarce. Lymphoedema affects up to 70% of breast and prostate cancer patients, substantially increasing their postoperative medical costs. Adding to this problem ar...
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People with a medical history of diabetes and diabetic foot ulcers were surveyed to determine what the barriers to obtaining pressure redistribution devices were in the community. The results indicated that the most prominent barriers to obtaining pressure redistribution devices were cost and convenience, despite being educated about its importance...
Article
Although the total contact cast is the criterion standard for the pressure redistribution of challenging foot ulcers, in practice it is not often feasible. The following is a case series that demonstrates an encouraging possibility for the Charcot restraint orthotic walker as a device to be used in more challenging forefoot ulcers.
Article
Debridement is integral to wound bed preparation by removing devitalised tissue, foreign material, senescent cells, phenotypically abnormal/dysfunctional cells (cellular burden) and bacteria sequestrum (biofilm). While the body of evidence to substantiate the benefits of debridement is growing, little is known about the cost-effectiveness of each d...
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The aim of this study was to gather data from Canadian stakeholders to help construct a national strategy and agenda for lymphedema management. The Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema therapists, patient advocates, and others, used participatory action research and Open Space Technology to identify issues...
Article
PURPOSE: To enhance the learner's knowledge and competence in wound bed preparation. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Assess wounds to classify t...
Article
To investigate whether electric stimulation therapy (EST) administered as part of a community-based, interdisciplinary wound care program accelerates healing of pressure ulcers in people with spinal cord injury (SCI). Single-blind, parallel-group, randomized, controlled, clinical trial. Community-based home care setting, Ontario, Canada. Adults (N=...
Article
To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI). For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO. To be selected for inclusion in the current review, there had to have been an intervention, studies had to...
Article
Purpose: To provide the specialist in skin and wound care with an update in recommended management of venous leg ulcers. Target audience: This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders. Objectives: After reading this article and taking this test, the reader should b...
Article
PURPOSE: To provide the specialist in skin and wound care with an update in recommended management of venous leg ulcers. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders. OBJECTIVES: After reading this article and taking this test, the reader should be abl...
Article
Purpose: The purpose of this article is to enhance the professional nurses' knowledge of the best practice recommendations for the prevention and treatment of pressure ulcers. Target audience: This continuing education activity is intended for physicians and nurses with an interest in wound care. Objectives: After reading this article and taki...
Article
PURPOSE: To provide the best available evidence in care of patients with chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians, and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Identify local factors and recommendations f...
Article
PURPOSE: To provide the best available evidence in care of patients with chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Identify local factors and recommendations fo...
Chapter
IntroductionErythropoietin as a Potential Growth Factor in Wound HealingClinical Experience with Recombinant Human Erythropoietin and Patients with Pressure UlcersConclusions and Future ResearchReferences
Article
Ultraviolet light C (light wavelength 200 nm to 290 nm) has been shown to kill cultures of antibiotic resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus. To evaluate the ability of ultraviolet light C to reduce the amount and type of bacteria present in chronically infected ulcers, as well as to establish the test-ret...
Article
Patients with hemoglobin greater than or equal to 100 g/L may have difficulty healing pressure ulcers because of impaired tissue oxygenation. Decreased hemoglobin is often anemia of chronic disease and may be due to the effects of inflammatory cytokines on erythroid progenitor cells. Recombinant human erythropoietin has been found to reverse anemia...
Article
The effective management of nonhealing wounds is based on a complete patient history, a detailed initial assessment of the wound, and an analysis of probable causative factors. This information is used to individualize a management strategy to the underlying pathophysiology preventing healing and to implement appropriate wound interventions. Regula...
Article
To develop and validate an assessment tool--the Leg Ulcer Measurement Tool (LUMT)--that would be able to detect changes in the appearance of lower extremity ulcers. Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. An interdisciplinary panel consisting of 9 local wou...
Article
This report describes the pilot testing of an educational intervention to manage acute pain associated with wound care in an outpatient clinic. The intervention included essential elements of pain education identified in the acute pain literature: provision of information; pain measurement; establishing expectations; treatment planning; teaching en...
Article
OBJECTIVE: This report describes the pilot testing of an educational intervention to manage acute pain associated with wound care in an outpatient clinic. The intervention included essential elements of pain education identified in the acute pain literature: provision of information; pain measurement; establishing expectations; treatment planning;...
Article
The effective management of nonhealing wounds is based on a complete patient history, a detailed initial assessment of the wound, and an analysis of probable causative factors. This information is used to individualize a management strategy to the underlying pathophysiology preventing healing and to implement appropriate wound interventions. Regula...
Article
Full-text available
Wound bed preparation is the promotion of wound closure through diagnosis of the cause, attention to patient-centered concerns, and correction of systemic and local factors that may delay healing. To enhance the evidence base that may be lacking, a review of relevant literature was conducted and combined with input from the International Wound Bed...
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To determine family physicians' perceptions of and attitudes toward leg ulcer care and awareness of effective treatments for venous leg ulcers. Self-administered, cross-sectional faxed and mailed survey. Ottawa-Carleton, Ont. All physicians in the region who were members of the College of Family Physicians of Canada. Response rate was 62%. During 1...
Article
Chronic wound pain is distressing and influences the patient's ability to function. One of the failures of modern medicine is the inadequate assessment and treatment of pain. The clinician's approach to chronic wound pain combines the "preparing the wound bed" paradigm with chronic wound pain models. A holistic approach must include the diagnosis a...
Article
Integrating pain management into a treatment paradigm for pressure ulcers can lead to improved outcomes. An approach to wound bed preparation that addresses the cause and patient-centered concerns--as well as local wound care factors of moisture balance, debridement, and bacterial balance--can be integrated with the Krasner model of chronic wound p...
Article
Electrical current has been recommended for use on chronic pressure ulcers; however, the ability of this modality to improve healing of other types of chronic ulcers is less well established. The purpose of this study was to examine the effect of high-voltage pulsed current (HVPC) on healing of chronic leg ulcers. Twenty-seven people with 42 chroni...
Article
Wear time of a dressing in the clinical setting is based on both the properties of the dressing and the wound. Many in-vitro models do not account for many of the problems encountered in clinical practice, especially in older patients. Hydrocolloid dressings are both absorptive and adhesive and, as such, are often used to cover wounds in difficult...
Article
Full-text available
Background and Purpose. Electrical current has been recommended for use on chronic, pressure ulcers; however, the ability of. this modality to improve healing of other types of chronic ulcers is less well established. The purpose of this study was to examine the effect of high-voltage pulsed current (HVPC) on, healing of chronic leg ulcers. Subject...
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Full-text available
Accurate and precise wound measurements are a critical component of every wound assessment. To examine the reliability and validity of a new computerized technique for measuring human and animal wounds, chronic human wounds (N = 45) and surgical animal wounds (N = 38) were assessed using manual and computerized techniques. Using intraclass correlat...
Article
Healthcare professionals use words like "frustrating," "expensive," and "time-consuming" to describe chronic wound care. Healing a wound that has been present for an extended period of time is difficult. Often the problem is not just the wound but also the "woundedness" of the individual with the wound. The patient's needs in chronic wound care oft...
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Full-text available
Successful diagnosis and treatment of patients with chronic wounds involve holistic care and a team approach. The integration of the work of an interdisciplinary care team that includes doctors, nurses, and allied health professionals with the patient, family, significant others, and caregivers offers an optimal formula for achieving wound resoluti...
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In this article, the Canadian Association of Wound Care puts forward 12 recommendations for best practices in the prevention and treatment of pressure ulcers that focus on an interdisciplinary patient-centered approach. These recommendations are a synthesis of the Agency for Health Care Policy and Research guidelines, European guidelines, and curre...
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To determine family physicians' perceptions of how available respite care is and how easy it is to refer chronically ill older people to it, and to examine their opinions of respite care. Mailed survey to family physicians on the Thames Valley Family Practice Research Unit's mailing list. London, Ont, and surrounding area. Of the 448 surveys mailed...
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Full-text available
The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT)...
Article
Numerous evaluation tools have been developed to document various aspects of wound status or appearance of pressure ulcers. These include the Pressure Sore Status Tool (PSST), Pressure Ulcer Scale for Healing (PUSH Tool), Sussman Wound Healing Tool (SWHT), Sessing scale, and the Wound Healing Scale (WHS). A critical appraisal of the literature was...
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Full-text available
To examine the frequency of presentation to family physicians' offices for cold symptoms, the reasons for presentation, and the duration of symptoms before presentation. Prospective cross-sectional survey. One hundred consecutive patient encounters in each of 15 family practices from January 27 to February 3, 1994, involving both academic and non-a...
Article
A chronic wound should prompt a search for the underlying causes. Knowledge of the physiology of the normal wound healing trajectory through the stages of hemostasis, inflammation, granulation, and maturation provides a framework for understanding the advantages of moist interactive wound healing. Good chronic wound care is patient-centered, holist...

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