I have long been fascinated by the prediction of wound healing. Well over 15 years ago Dr. David Margolis and his colleagues told us—and still tell us today—that simpler models are better, that starting with initial wound age and area and a grading of the severity of the chronic wound is all we really need [1,2]. In other words, predicting whether a wound will heal at a specified point further in time is relatively straightforward. So, why is there still so much debate about the subject? The simple answer is that while Margolis and his colleagues certainly did their homework, their approach rests on the premise that with certain caveats, what you cannot observe cannot make much of a difference if it doesn’t change outcome estimates that much. In their words: “With the exception of wound grade, the unadjusted versus fully adjusted effect estimates did not differ by 10%, indicating that the unadjusted estimates were not confounded by the other risk factor variables” . We have since learned that use of change-in-estimate criteria with a fixed cutoff level (e.g., 10%), have been found inappropriate , which makes meaningful modeling very much harder. But there is another problem, and it’s a big one, and hard to assess in a paper when it’s not reported. [CLICK HERE TO READ THE REST OF THE ARTICLE]
Dr. Marissa Carter was born in England and obtained an MA in biochemistry from Oxford University. Following a brief research period at St. Bartholomew’s Hospital in London on the pineal gland, she moved to the United States, where she spent 2 years as a fellow at MIT. In 1986 she graduated from Brandeis University with a PhD in organometallic chemistry, publishing several groundbreaking papers. From that time until late 1999, she held a variety of positions in the chemical and plastics industries, working in basic laboratory R&D, pilot plants, and full-sized chemical plants. She has also worked in Sales, Marketing, Technical Service, as well as Product Development, thus gaining insight into best practices of teams, TQM, and project management. Since the inception of SSI, she returned to medical research, and has collaborated with several groups in the areas of ophthalmology, wound care, evidence-based medicine, and epidemiology, the results of which have been recently published, with many more papers in press. Dr Carter’s strengths lie in the many scientific disciplines in which she worked that she brings to bear on medical problems. She is a peer reviewer for the journals Wound Repair Regeneration, International Wound Journal, Ophthalmology, Journal of Infection, Eye, and many others. More recently she has also been given that task of managing the Global Indicators Field Testing Project to Pilot the WHO Global Indicators in Latin America (eye care). Education: Oxford University, Oxford, England M.A. in Biochemistry; Post-graduate: Brandeis University, Waltham, MA Ph.D. in Chemistry.
For more great information from Dr. Carter, visit her website and definitely her Blog!
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Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/channel/UCbxBv_PCAYkbUCvnCjTzW0A/videos