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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

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